Provider Demographics
NPI:1831888171
Name:RISE CONSULTING AND PSYCHOLOGICAL SERVICES LLC.
Entity type:Organization
Organization Name:RISE CONSULTING AND PSYCHOLOGICAL SERVICES LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:PYSYD
Authorized Official - Phone:937-248-3320
Mailing Address - Street 1:1305 GLENRIDGE CT N
Mailing Address - Street 2:
Mailing Address - City:MINOOKA
Mailing Address - State:IL
Mailing Address - Zip Code:60447-4572
Mailing Address - Country:US
Mailing Address - Phone:937-248-3320
Mailing Address - Fax:
Practice Address - Street 1:6323 N AVONDALE AVE STE 245B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-1999
Practice Address - Country:US
Practice Address - Phone:312-248-1647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-03
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty