Organization
PHC OF BUFFALO GROVE CLINICAL PSYCHOLOGY
Active
Other names
Portrait Health Centers
Organization subpart
No
Provider details
NPI number
Authorized official
JEREMY WARNER (PRACTICE MANAGER)
(847) 868-3435
Entity
Organization
Contact information
Practice address
175 E HAWTHORN PKWY, SUITE 235, VERNON HILLS, IL 60061-1463
(847) 868-3435
(847) 859-5885
Mailing address
175 E HAWTHORN PKWY, SUITE 235, VERNON HILLS, IL 60061-1463
(847) 868-3435
(847) 859-5885
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071007099
IL
133V00000X
Registered Dietitian
164005333
IL
Other
Enumeration date
11/16/2010
Last updated
09/06/2013
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