NPIMap

Organization Active NPI

Chicago Cognitive Behavioral Treatment Center

  • Clinical Psychologist
  • Skokie, IL
National Provider Identifier
1457676322
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
CHICAGO COGNITIVE BEHAVIORAL TREATMENT CENTER
Practice address
4711 Golf Rd Ste 520
Skokie, IL 60076-1224
Phone
(847) 966-9343
Fax
(847) 966-9536
NPI assigned
Apr 2, 2010
Last updated
Mar 17, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Authorized official

Name
Dr. Amanda Louise Holly, PH.D.NPI 1922393099
Title
Clinical Psychologist
Phone
(773) 680-0922

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X IL
Cognitive & Behavioral PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TB0200X
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

4711 Golf Rd Ste 520
Skokie, IL 60076-1224

Mailing address

4711 Golf Rd Ste 520
Skokie, IL 60076-1224
Phone (847) 966-9343

Other practice location 1

4711 Golf Rd Ste 520
Skokie, IL 60076-1224
Phone (847) 966-9343

National Provider Directory

National Provider Directory

Locations

4711 Golf Rd
Ste 520
Skokie, IL 60076
Phone (847) 966-9343

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1270166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521244800000",
    "number": "1457676322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4711 GOLF RD STE 520",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761224",
            "telephone_number": "847-966-9343",
            "fax_number": "847-966-9536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4711 GOLF RD STE 520",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600761224",
            "telephone_number": "847-966-9343",
            "fax_number": "847-966-9536"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4711 Golf Rd Ste 520",
            "address_purpose": "LOCATION",
            "city": "Skokie",
            "state": "IL",
            "postal_code": "600761224",
            "country_code": "US",
            "telephone_number": "847-966-9343",
            "fax_number": "847-966-9536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHICAGO COGNITIVE BEHAVIORAL TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-02",
        "last_updated": "2018-03-17",
        "status": "A",
        "authorized_official_last_name": "HOLLY",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "773-680-0922",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Skokie, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.