Healthcare Provider Details

I. General information

NPI: 1619035730
Provider Name (Legal Business Name): ASSOCIATES IN THERAPY AND ASSESSMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 02/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NORTH SHORE DR. SUITE 200
LAKE BLUFF IL
60044-2225
US

IV. Provider business mailing address

900 NORTH SHORE DR. SUITE 200
LAKE BLUFF IL
60044-2225
US

V. Phone/Fax

Practice location:
  • Phone: 847-295-6141
  • Fax: 888-765-7036
Mailing address:
  • Phone: 847-295-6141
  • Fax: 888-765-7036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DAVID HANSON
Title or Position: CO-OWNER
Credential: PSY.D.
Phone: 847-295-6141