Provider Demographics
NPI:1447629142
Name:C.L.O. PSYCHOLOGICAL, SERV.
Entity type:Organization
Organization Name:C.L.O. PSYCHOLOGICAL, SERV.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-618-2231
Mailing Address - Street 1:925 KILLARNEY DR
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1292
Mailing Address - Country:US
Mailing Address - Phone:773-618-2231
Mailing Address - Fax:
Practice Address - Street 1:925 KILLARNEY DR
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1292
Practice Address - Country:US
Practice Address - Phone:773-618-2231
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health