Healthcare Provider Details

I. General information

NPI: 1003569542
Provider Name (Legal Business Name): TIKVAH CENTER FOR JEWISH RECOVERY AND HEALING NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2022
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3320 DUNDEE RD
NORTHBROOK IL
60062-2303
US

IV. Provider business mailing address

3320 DUNDEE RD
NORTHBROOK IL
60062-2303
US

V. Phone/Fax

Practice location:
  • Phone: 847-917-7725
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: ROBERT JURY
Title or Position: OWNER
Credential: LCPC
Phone: 847-917-7725