Individual
JONATHAN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
5412 N CLARK ST STE 220, CHICAGO, IL 60640-1272
(773) 985-8746
Mailing address
5412 N CLARK ST STE 220, CHICAGO, IL 60640-1272
(773) 985-8746
(773) 880-1321
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
178.010187
IL
103TC0700X
Clinical Psychologist
Primary
071.009490
IL
Other
Enumeration date
07/20/2015
Last updated
10/01/2020
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