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General NPI Number Information
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NPI Number | 1285384248
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Entity Type | Organization
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Legal Business Name | TABULARASA INTEGRATIVE HEALTH INC
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 135 N GREENLEAF ST STE 120
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City | GURNEE
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State | IL
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Zip | 60031-3334
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Country | US
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Telephone | 224-430-8109
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Fax |
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Provider Business Mailing Address
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Address Line | 135 N GREENLEAF ST STE 120
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City | GURNEE
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State | IL
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Zip | 60031-3334
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Country | US
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Telephone | 224-285-0728
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Fax | 224-249-4411
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Authorized Official
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Title or Position | PARTNER
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Name | MS. KIM BARKUS
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Credential | LCPC, CADC, CCTP-II
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Telephone | 224-430-8109
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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