Organization
ADVANCE POTENTIAL PSYCHOLOGICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLENN AUGUST SEVIER LCSW (CEO/EXCUTIVE PRESIDENT)
(773) 512-8813
Entity
Organization
Contact information
Practice address
2007 W GREENLEAF AVE, CHICAGO, IL 60645-3509
(773) 512-8813
(773) 743-7696
Mailing address
2007 W GREENLEAF AVE, CHICAGO, IL 60645-3509
(773) 512-8813
(773) 743-7696
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
492722592001
—
IL
Enumeration date
06/06/2012
Last updated
07/31/2013
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