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Organization
THE NEUROFEEDBACK AND COGNITIVE TRAINING INSTITUTE OF GREATER CHICAGO
Active
Organization
THE NEUROFEEDBACK AND COGNITIVE TRAINING INSTITUTE OF GREATER CHICAGO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCIA SUSAN GIBSON PSY.D. (VICE-PRESIDENT)
(630) 759-1732
Entity
Organization
Contact information
Practice address
404 W BOUGHTON RD, SUITE B, BOLINGBROOK, IL 60440-1898
(630) 759-1732
(630) 759-5220
Mailing address
404 W BOUGHTON RD, SUITE B, BOLINGBROOK, IL 60440-1898
(630) 759-1732
(630) 759-5220
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
071007322
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTAN IS IL 3090
MEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN) IS IL3090
IL
Enumeration date
10/13/2011
Last updated
10/13/2011
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