Organization
MICHAEL S BLACK PH D AND PARK PSYCHOLOGICAL SERVICES LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL STUART BLACK PH.D. (PRESIDENT)
(847) 835-5517
Entity
Organization
Contact information
Practice address
473 PARK AVE, GLENCOE, IL 60022-1549
(847) 835-5517
(847) 835-3321
Mailing address
473 PARK AVE, GLENCOE, IL 60022-1549
(947) 835-5517
(847) 835-3321
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071-000739
IL
Other
Enumeration date
02/16/2009
Last updated
02/16/2009
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