Organization
PSYCHIATRY SPECIALISTS P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACY CLOYD (SECRETARY)
(904) 605-4986
Entity
Organization
Contact information
Practice address
4535 N BEACON ST, CHICAGO, IL 60640-5518
(773) 629-0716
Mailing address
4535 N BEACON ST, CHICAGO, IL 60640-5518
(773) 629-0716
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1700042454
NPI 1700042454
IL
Enumeration date
08/12/2011
Last updated
06/19/2023
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