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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