Healthcare Provider Details

I. General information

NPI: 1003868472
Provider Name (Legal Business Name): AFFILIATES IN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 04/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 SKOKIE BLVD 260
NORTHBROOK IL
60062-2858
US

IV. Provider business mailing address

910 SKOKIE BLVD 215
NORTHBROOK IL
60062-4013
US

V. Phone/Fax

Practice location:
  • Phone: 847-480-0300
  • Fax: 847-291-0576
Mailing address:
  • Phone: 847-480-0300
  • Fax: 847-291-0576

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
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MORTON C MIRMAN
Title or Position: PARTNER
Credential: PH.D.
Phone: 847-480-0300