NPIMap

Organization Active NPI

Corespace Counseling, LLC

  • Clinical Psychologist
  • Tinley Park, IL
National Provider Identifier
1225425713
Registry record updated Jul 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071008860 Issued in IL
Legal business name
CORESPACE COUNSELING, LLC
Practice address
16335 Harlem Ave
Suite 401
Tinley Park, IL 60477-2574
Phone
(773) 332-7832
NPI assigned
Apr 22, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2015

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

Authorized official

Name
Dr. Ryan Kerzman, PSYDNPI 1679812192
Title
Clinical Director
Phone
(773) 332-7832

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X 071008860 IL Primary

Addresses

Primary practice location

16335 Harlem Ave
Suite 401
Tinley Park, IL 60477-2574

Mailing address

16335 Harlem Ave
Suite 401
Tinley Park, IL 60477-2574
Phone (773) 332-7832

National Provider Directory

National Provider Directory

Locations

16335 Harlem Ave
Ste 401
Tinley Park, IL 60477
Phone (773) 332-7832

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1429660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437955200000",
    "number": "1225425713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16335 HARLEM AVE",
            "address_2": "SUITE 401",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604772574",
            "telephone_number": "773-332-7832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16335 HARLEM AVE",
            "address_2": "SUITE 401",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604772574",
            "telephone_number": "773-332-7832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORESPACE COUNSELING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-22",
        "last_updated": "2015-07-27",
        "status": "A",
        "authorized_official_last_name": "KERZMAN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "773-332-7832",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008860",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tinley Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2015; 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.