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General NPI Number Information
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NPI Number | 1225260458
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Entity Type | Organization
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Legal Business Name | TARA GIDNEY THOMPSON & ASSOCIATES,PC
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Dates
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Enumeration Date | 08/21/2009
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Last Update Date | 08/21/2009
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Provider Practice Location Address
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Address Line | 307 N MICHIGAN AVE SUITE 2024
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City | CHICAGO
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State | IL
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Zip | 60601-5311
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Country | US
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Telephone | 773-879-8272
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Fax |
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Provider Business Mailing Address
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Address Line | 307 N MICHIGAN AVE SUITE 2024
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City | CHICAGO
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State | IL
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Zip | 60601-5311
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Country | US
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Telephone | 773-879-8272
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. TARA GIDNEY THOMPSON
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Credential | PSYD
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Telephone | 773-879-8272
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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 | 071007131
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License Number State | IL
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