The Neurofeedback and Cognitive Training Institute of Greater Chicago

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

License

071007322 Issued in IL

Legal business name

THE NEUROFEEDBACK AND COGNITIVE TRAINING INSTITUTE OF GREATER CHICAGO

Practice address

404 W Boughton Rd
Suite B
Bolingbrook, IL 60440-1898

Phone

(630) 759-1732

Fax

(630) 759-5220

NPI assigned

Oct 13, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Marcia Susan Gibson, PSY.D.

Title

Vice-President

Phone

(630) 759-1732

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1318464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318464000000",
    "number": "1568747202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 W BOUGHTON RD",
            "address_2": "SUITE B",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401898",
            "telephone_number": "630-759-1732",
            "fax_number": "630-759-5220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 W BOUGHTON RD",
            "address_2": "SUITE B",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604401898",
            "telephone_number": "630-759-1732",
            "fax_number": "630-759-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE NEUROFEEDBACK AND COGNITIVE TRAINING INSTITUTE OF GREATER CHICAGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-13",
        "last_updated": "2011-10-13",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_middle_name": "SUSAN",
        "authorized_official_title_or_position": "VICE-PRESIDENT",
        "authorized_official_telephone_number": "630-759-1732",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IL",
            "license": "071007322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER TRANSACTION ACCESS NUMBER (PTAN) IS IL3090",
            "identifier": "PTAN IS IL 3090",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Joann Taylor, LCPC, CADC
• Holly Thalheimer, PHARMD
• Antony R Tharian, M.D.
• The Centre, LLC
• The Mahogany Berry LLC
• The Rebirth Organization
• The Right Pharmacy Inc
• Thea C. Flock, D.C., S.C.
• Jaison J Thekkekara, M.D.
• Lauren Julia Thibault, DPT

• Mental Health Clinic/Center (Including Community Mental Health Center) in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2011; 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.