Provider Demographics
NPI:1255349411
Name:NEUROPSYCHIATRIC ASSOCIATES OF IL SC
Entity type:Organization
Organization Name:NEUROPSYCHIATRIC ASSOCIATES OF IL SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:GLICK
Authorized Official - Last Name:GALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-367-1611
Mailing Address - Street 1:977 LAKEVIEW PKWY
Mailing Address - Street 2:SUITE 170
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-1400
Mailing Address - Country:US
Mailing Address - Phone:847-367-1611
Mailing Address - Fax:847-367-4079
Practice Address - Street 1:977 LAKEVIEW PKWY
Practice Address - Street 2:SUITE 170
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1400
Practice Address - Country:US
Practice Address - Phone:847-367-1611
Practice Address - Fax:847-367-4079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0571052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty