Advance Potential Psychological Services, LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

ADVANCE POTENTIAL PSYCHOLOGICAL SERVICES, LLC

Practice address

2007 W Greenleaf Ave
Chicago, IL 60645-3509

Phone

(773) 512-8813

Fax

(773) 743-7696

NPI assigned

Jun 6, 2012

Last updated

Jul 31, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Glenn August Sevier, LCSWNPI 1669784989

Title

Ceo/Excutive President

Phone

(773) 512-8813

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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.

• Glenn August Sevier, LCSW

  • Clinical Social Worker
  • Chicago, IL
  • NPI 1669784989
  Medicare reassignment Authorized official
• Lea Sevier, PH.D.

  • Psychologist
  • Chicago, IL
  • NPI 1649340118
  NPD (past)

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

{
    "created_epoch": "1338940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375228800000",
    "number": "1922369941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2007 W GREENLEAF AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606453509",
            "telephone_number": "773-512-8813",
            "fax_number": "773-743-7696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2007 W GREENLEAF AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606453509",
            "telephone_number": "773-512-8813",
            "fax_number": "773-743-7696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCE POTENTIAL PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-06",
        "last_updated": "2013-07-31",
        "status": "A",
        "authorized_official_last_name": "SEVIER",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "AUGUST",
        "authorized_official_title_or_position": "CEO/EXCUTIVE PRESIDENT",
        "authorized_official_telephone_number": "773-512-8813",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "492722592001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Behavioral Health Agency in Chicago, IL
• Providers in Chicago, IL by specialty
• Community/Behavioral Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.