Provider Demographics
NPI:1043517600
Name:JOY PREPEJCHAL PSYD SC
Entity type:Organization
Organization Name:JOY PREPEJCHAL PSYD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:PREPEJCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-364-0480
Mailing Address - Street 1:15010 S RAVINIA AVE
Mailing Address - Street 2:SUITE 15
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3162
Mailing Address - Country:US
Mailing Address - Phone:708-364-0580
Mailing Address - Fax:708-364-0480
Practice Address - Street 1:15010 S RAVINIA AVE
Practice Address - Street 2:SUITE 15
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3162
Practice Address - Country:US
Practice Address - Phone:708-364-0580
Practice Address - Fax:708-364-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007842261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)