Healthcare Provider Details

I. General information

NPI: 1154708899
Provider Name (Legal Business Name): INSTITUTE FOR THERAPY THROUGH THE ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 SHERMAN AVE STE 100
EVANSTON IL
60201-4361
US

IV. Provider business mailing address

1316 SHERMAN AVE STE 100
EVANSTON IL
60201-4361
US

V. Phone/Fax

Practice location:
  • Phone: 847-425-9708
  • Fax: 847-448-8337
Mailing address:
  • Phone: 847-425-9708
  • Fax: 847-448-8337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code225600000X
TaxonomyDance Therapist
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: FREDERICA MELANIE MALONE
Title or Position: CLINICAL DIRECTOR
Credential: LCPC
Phone: 847-425-9708