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General NPI Number Information
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NPI Number | 1154832913
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Entity Type | Organization
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Legal Business Name | TARYN K THERAPY LLC
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 10/19/2017
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Provider Practice Location Address
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Address Line | 2500 W BRADLEY PL
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City | CHICAGO
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State | IL
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Zip | 60618-4716
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Country | US
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Telephone | 872-267-4041
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Fax |
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Provider Business Mailing Address
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Address Line | 2500 W BRADLEY PL
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City | CHICAGO
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State | IL
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Zip | 60618-4716
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Country | US
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Telephone | 872-267-4041
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TARYN MICHELLE KONEVICH
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Credential | LCSW
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Telephone | 872-267-4041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 149.019494
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License Number State | IL
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