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14D2147798 CLIA NUMBER - RUSH AMBULATORY BEHAVIORAL HEALTH

Laboratory Demographics

CLIA Number: 14D2147798

Facility Name: RUSH AMBULATORY BEHAVIORAL HEALTH

Facility Address:
2150 W HARRISON ST - BSMT - STE 007 ATTN FRANCES PEREZ
CHICAGO, IL
ZIP 60612
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Facility Phone Number: 312 942-5375

Facility Type: Physician Office

Certificate Type: Waiver
NPI Number: 1437344207

Taxonomy: 103T00000X - Psychologist
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

CLIA Record

Field Name Field Value
CLIA Number 14D2147798
LAB Type Physician Office
Facility Name RUSH AMBULATORY BEHAVIORAL HEALTH
Street 2150 W HARRISON ST - BSMT - STE 007 ATTN FRANCES PEREZ
City CHICAGO
State IL
ZIP 60612
Phone 312 942-5375
CertificateType 4
CertificateEffectiveDate 4/26/2024
CertificateExpirationDate 4/25/2026
FacilityType Waiver

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This page was last updated on: 4/23/2024