Providence Center for Psychological Services

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071006625 Issued in IL

Legal business name

PROVIDENCE CENTER FOR PSYCHOLOGICAL SERVICES

Practice address

100 W Roosevelt Rd # B-203
Wheaton, IL 60187-5260

Phone

(630) 221-0600

Fax

(630) 221-0606

NPI assigned

Aug 27, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Keena Peek, PSY.D.

Title

Owner/Psychologist

Phone

(630) 221-0600

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1377561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377561600000",
    "number": "1699109587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 W ROOSEVELT RD # B-203",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601875260",
            "telephone_number": "630-221-0600",
            "fax_number": "630-221-0606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W ROOSEVELT RD # B-203",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601875260",
            "telephone_number": "630-221-0600",
            "fax_number": "630-221-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE CENTER FOR PSYCHOLOGICAL SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-27",
        "last_updated": "2013-08-27",
        "status": "A",
        "authorized_official_last_name": "PEEK",
        "authorized_official_first_name": "KEENA",
        "authorized_official_title_or_position": "OWNER/PSYCHOLOGIST",
        "authorized_official_telephone_number": "630-221-0600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071006625",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2013; 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.