Comprehensive Health Agency Nurturing Guest Enervation

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.006944 Issued in IL

Legal business name

COMPREHENSIVE HEALTH AGENCY NURTURING GUEST ENERVATION

Doing business as

C.H.A.N.G.E. OF Illinois

Practice address

14719 Halsted St
Harvey, IL 60426-1920

Phone

(708) 331-2679

NPI assigned

Aug 14, 2008

Last updated

Aug 14, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kimberly Kenner Wash

Title

Director

Phone

(708) 331-2679

Specialties & licenses 4

Addresses

Other names 1

• C.H.A.N.G.E. OF Illinois Doing business as

Locations

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

{
    "created_epoch": "1218672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218672000000",
    "number": "1174779771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14719 HALSTED ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604261920",
            "telephone_number": "708-331-2679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14719 HALSTED ST",
            "city": "HARVEY",
            "state": "IL",
            "postal_code": "604261920",
            "telephone_number": "708-331-2679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE HEALTH AGENCY NURTURING GUEST ENERVATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-14",
        "last_updated": "2008-08-14",
        "status": "A",
        "authorized_official_last_name": "WASH",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "KENNER",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "708-331-2679"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.006944",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.106435",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IL",
            "license": "036.109938",
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "C.H.A.N.G.E. OF Illinois",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jack A Cohen, MD
• Tonya Echols Cole, M.D.
• Betty Coleman-Bradley
• Rashonda Collins, P.A.
• Community Dialysis LLC (Community Dialysis of Harvey)
• Comprehensive Pain Care SC
• Mary G Conway, PT
• Denice D Cook, M.D.
• Cornerstone Suppport Cila Home
• Joseph B Costa, MD

• Clinical Psychologist in Harvey, IL
• Providers in Harvey, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2008; 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.