NPIMap

Organization Active NPI

Center for Personal Growth, PLLC

  • Clinical Psychologist
  • Carol Stream, IL
National Provider Identifier
1831594407
Registry record updated Feb 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071.008385 Issued in IL
Legal business name
CENTER FOR PERSONAL GROWTH, PLLC
Practice address
640 E Saint Charles Rd Ste 212
Carol Stream, IL 60188-2600
Phone
(630) 791-0118
Fax
(630) 708-7654
NPI assigned
Oct 25, 2014
Last updated
Feb 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2024

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

Authorized official

Name
Mrs. Kiera E Liebich
Title
Office Manager
Phone
(630) 791-0118

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 071.008385 IL Primary
Clinical Child & Adolescent Psychologist 103TC2200X 071.008385 IL
Health Service Psychologist 103TH0100X NU

Addresses

Primary practice location

640 E Saint Charles Rd Ste 212
Carol Stream, IL 60188-2600

Mailing address

640 E Saint Charles Rd Ste 212
Carol Stream, IL 60188-2600
Phone (630) 791-0118

Other identifiers 1

IdentifierTypeStateIssuer
321707109001MedicaidIL

Other names 1

  • Center for Personal Growth Other name

National Provider Directory

National Provider Directory

Locations

350 S Schmale Rd
Ste 180
Carol Stream, IL 60188
Phone (630) 791-0118

640 E Saint Charles Rd
Ste 212
Carol Stream, IL 60188
Phone (630) 791-0118

Practitioners & affiliated clinicians

Practitioners 10

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": "1414195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708732800000",
    "number": "1831594407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 E SAINT CHARLES RD STE 212",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882600",
            "telephone_number": "630-791-0118",
            "fax_number": "630-708-7654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 E SAINT CHARLES RD STE 212",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601882600",
            "telephone_number": "630-791-0118",
            "fax_number": "630-708-7654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR PERSONAL GROWTH, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-25",
        "last_updated": "2024-02-24",
        "certification_date": "2023-11-02",
        "status": "A",
        "authorized_official_last_name": "LIEBICH",
        "authorized_official_first_name": "KIERA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "630-791-0118",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.008385",
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "IL",
            "license": "071.008385",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "321707109001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Personal Growth",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Center for Personal Growth",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Carol Stream, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2024; 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.