Provider Demographics
NPI: | 1003527094 |
---|---|
Name: | COMPREHENSIVE PSYCHOLOGICAL & HEALTH ASSOCIATION LLC |
Entity type: | Organization |
Organization Name: | COMPREHENSIVE PSYCHOLOGICAL & HEALTH ASSOCIATION LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | CARNELL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | COLEBROOK-CLAUDE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | PHD, NCC, LCPC, LSOE |
Authorized Official - Phone: | 954-686-2020 |
Mailing Address - Street 1: | 1449 S MICHIGAN AVE STE 13127 |
Mailing Address - Street 2: | |
Mailing Address - City: | CHICAGO |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60605-2810 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 954-686-2020 |
Mailing Address - Fax: | 954-604-6506 |
Practice Address - Street 1: | 2501 CHATHAM ROAD |
Practice Address - Street 2: | #5714 |
Practice Address - City: | SPRINGFIELD |
Practice Address - State: | IL |
Practice Address - Zip Code: | 62704 |
Practice Address - Country: | US |
Practice Address - Phone: | 954-686-2020 |
Practice Address - Fax: | 954-604-6506 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-12-09 |
Last Update Date: | 2025-08-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103G00000X | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | Group - Multi-Specialty | |
No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
No | 103TA0700X | Behavioral Health & Social Service Providers | Psychologist | Adult Development & Aging | Group - Multi-Specialty |
No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
No | 103TE1100X | Behavioral Health & Social Service Providers | Psychologist | Exercise & Sports | Group - Multi-Specialty |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 103TF0000X | Behavioral Health & Social Service Providers | Psychologist | Family | Group - Multi-Specialty |
No | 103TF0200X | Behavioral Health & Social Service Providers | Psychologist | Forensic | Group - Multi-Specialty |
No | 103TH0004X | Behavioral Health & Social Service Providers | Psychologist | Health | Group - Multi-Specialty |
No | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
No | 103TP0814X | Behavioral Health & Social Service Providers | Psychologist | Psychoanalysis | Group - Multi-Specialty |
No | 103TP2701X | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy | Group - Multi-Specialty |