Healthcare Provider Details

I. General information

NPI: 1619356649
Provider Name (Legal Business Name): ENCOUNTER MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 05/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 S MAPLE AVE SUITE 3400
OAK PARK IL
60304-1091
US

IV. Provider business mailing address

610 S MAPLE AVE SUITE 3400
OAK PARK IL
60304-1091
US

V. Phone/Fax

Practice location:
  • Phone: 708-613-4750
  • Fax: 708-613-4754
Mailing address:
  • Phone: 708-613-4750
  • Fax: 708-613-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREA G. BARTHWELL
Title or Position: FOUNDER & CEO
Credential: MD, FASAM
Phone: 708-613-4750