Healthcare Provider Details

I. General information

NPI: 1245995026
Provider Name (Legal Business Name): INSIGHTFUL THERAPY, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 TOWER RD
SCHAUMBURG IL
60173-4309
US

IV. Provider business mailing address

1001 ROHLWING RD
ELK GROVE VILLAGE IL
60007-3217
US

V. Phone/Fax

Practice location:
  • Phone: 847-610-9189
  • Fax:
Mailing address:
  • Phone: 847-524-8800
  • Fax: 847-524-8824

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: MICHELLE KUKICH
Title or Position: PRESIDENT
Credential: LCPC
Phone: 847-610-9189