1275738130 NPI number — SHARED VISION PSYCHOLOGICAL SERVICES

Table of content: (NPI 1275738130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275738130 NPI number — SHARED VISION PSYCHOLOGICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARED VISION PSYCHOLOGICAL SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275738130
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 HARGER RD
Provider Second Line Business Mailing Address:
#600
Provider Business Mailing Address City Name:
OAK BROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-571-5750
Provider Business Mailing Address Fax Number:
630-571-5751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 HARGER RD
Provider Second Line Business Practice Location Address:
#600
Provider Business Practice Location Address City Name:
OAK BROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-571-5750
Provider Business Practice Location Address Fax Number:
630-571-5751
Provider Enumeration Date:
06/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAWRENCE
Authorized Official First Name:
MYRA
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
630-571-1110

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com