Healthcare Provider Details

I. General information

NPI: 1184592875
Provider Name (Legal Business Name): MY ABUNDANT LIFE THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2025
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3534 CLARENCE AVE
BERWYN IL
60402-3855
US

IV. Provider business mailing address

3534 CLARENCE AVE
BERWYN IL
60402-3855
US

V. Phone/Fax

Practice location:
  • Phone: 312-330-2561
  • Fax:
Mailing address:
  • Phone: 312-330-2561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER BAUMAN
Title or Position: CO-FOUNDER
Credential: LCSW, CADC
Phone: 630-426-9437