Healthcare Provider Details

I. General information

NPI: 1326973033
Provider Name (Legal Business Name): ALTI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15601 CICERO AVE STE 104
OAK FOREST IL
60452-3636
US

IV. Provider business mailing address

240 E WOODLAWN RD
NEW LENOX IL
60451-2288
US

V. Phone/Fax

Practice location:
  • Phone: 708-625-7523
  • Fax:
Mailing address:
  • Phone: 708-625-7523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JACOB MULTACK
Title or Position: MANAGING MEMBER
Credential: LPC
Phone: 708-625-7523