Organization
LYDIA HOME ASSOCIATION
Active
Organization
LYDIA HOME ASSOCIATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID K. ANDERSON PSY D (EXECUTIVE DIRECTOR)
(773) 736-1447
Entity
Organization
Contact information
Practice address
4300 W IRVING PARK RD #B, COUNSELING CENTER, CHICAGO, IL 60641-2825
(773) 736-1447
(773) 736-6970
Mailing address
4300 W IRVING PARK RD, COUNSELING CENTER, CHICAGO, IL 60641-2825
(773) 736-1447
(773) 736-6970
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
IL
103TC0700X
Clinical Psychologist
—
IL
103TC1900X
Counseling Psychologist
—
IL
103TC2200X
Clinical Child & Adolescent Psychologist
—
IL
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
04/27/2006
Last updated
02/25/2022
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