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General NPI Number Information
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NPI Number | 1275825796
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Entity Type | Organization
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Legal Business Name | EVOLVE PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 05/03/2011
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 155 N MICHIGAN AVE SUITE 760
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City | CHICAGO
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State | IL
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Zip | 60601-7511
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Country | US
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Telephone | 224-639-6909
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Fax |
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Provider Business Mailing Address
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Address Line | 155 NORTH MICHIGAN AVE SUITE 760
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City | CHICAGO
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State | IL
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Zip | 60601
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JILL SCHOENEMAN-PARKER
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Credential | PSY.D.
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Telephone | 224-639-6909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149006137
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149012341
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149002414
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.006224
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License Number State | IL
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