Healthcare Provider Details

I. General information

NPI: 1811355324
Provider Name (Legal Business Name): OHARA THERAPY OF CHICAGO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 W HALF DAY RD PMB 167
BUFFALO GROVE IL
60089-6547
US

IV. Provider business mailing address

2105 W BERWYN AVE 2N
CHICAGO IL
60625-1147
US

V. Phone/Fax

Practice location:
  • Phone: 224-637-0036
  • Fax:
Mailing address:
  • Phone: 224-637-0036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071009243
License Number StateIL

VIII. Authorized Official

Name: DR. ALISON L O'HARA
Title or Position: LICENSED CLINICAL PSYCHOLOGIST
Credential: PSYD
Phone: 224-637-0036