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General NPI Number Information
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NPI Number | 1093039836
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Entity Type | Organization
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Legal Business Name | YOUR A-GAME
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Dates
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Enumeration Date | 03/23/2010
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Last Update Date | 03/23/2010
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Provider Practice Location Address
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Address Line | 10024 SKOKIE BLVD SUITE #312
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City | SKOKIE
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State | IL
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Zip | 60077
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Country | US
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Telephone | 847-602-1380
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Fax | 224-233-1033
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Provider Business Mailing Address
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Address Line | 10024 SKOKIE BLVD SUITE #312
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City | SKOKIE
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State | IL
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Zip | 60077
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Country | US
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Telephone | 847-602-1380
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Fax | 224-233-1033
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL AISENBERG
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Credential | PSY.D.
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Telephone | 847-602-1380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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