Provider Demographics
NPI:1982876116
Name:ALLIED PSYCHOLOGICAL SERVICES LTD
Entity Type:Organization
Organization Name:ALLIED PSYCHOLOGICAL SERVICES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PREPURA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-680-3828
Mailing Address - Street 1:501 PETERSON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1082
Mailing Address - Country:US
Mailing Address - Phone:847-680-3828
Mailing Address - Fax:847-680-3844
Practice Address - Street 1:501 PETERSON RD STE 101
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1082
Practice Address - Country:US
Practice Address - Phone:847-680-3828
Practice Address - Fax:847-680-3844
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLIED PSYCHOLOGICAL SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-27
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL6393101YA0400X
IL6392101YA0400X
IL180001252101YP2500X
IL071002565103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL4923581OtherBLUE CROSS BLUE SHIELD