| NPI | 1558536094 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TARA GIDNEY THOMPSON Partner/Owner 847-722-5967 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071007131) |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization (Licence: IL 071.007131) |
| 302R00000X Health Maintenance Organization (Licence: IL 071.007131) | |
| 305R00000X Preferred Provider Organization (Licence: IL 071.007131) | |
| 305S00000X Point of Service (Licence: IL 071.007131) | |
| Enumeration Date | 2008-04-25 |
| Last Update Date | 2008-09-24 |