Illinois Psych Services PLLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

ILLINOIS PSYCH SERVICES PLLC

Practice address

738 E Dundee Rd
Palatine, IL 60074-2858

Phone

(330) 536-3746

Fax

(330) 267-4250

NPI assigned

May 25, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robert Sean Rae, MD

Title

Medical Director

Phone

(330) 536-3746

Specialties & licenses 2

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629763200000",
    "number": "1073188744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3593 MEDINA RD STE 181",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442568182",
            "telephone_number": "330-536-3746",
            "fax_number": "330-267-4250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "738 E DUNDEE RD",
            "city": "PALATINE",
            "state": "IL",
            "postal_code": "600742858",
            "telephone_number": "330-536-3746",
            "fax_number": "330-267-4250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ILLINOIS PSYCH SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-25",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A",
        "authorized_official_last_name": "RAE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "SEAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "330-536-3746",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Palatine, IL
• Providers in Palatine, IL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.