Healthcare Provider Details

I. General information

NPI: 1346361961
Provider Name (Legal Business Name): ALEXIS LYBROOK TAUBERT, PH.D, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 S MICHIGAN AVE APT 1309
CHICAGO IL
60605-3402
US

IV. Provider business mailing address

1305 S MICHIGAN AVE APT 1309
CHICAGO IL
60605-3402
US

V. Phone/Fax

Practice location:
  • Phone: 773-227-7597
  • Fax:
Mailing address:
  • Phone: 773-227-7597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number060-007678
License Number StateIL

VIII. Authorized Official

Name: DR. ALEXIS LYBROOK TAUBERT
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 773-248-4544