=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285729384
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSIGHTS PSYCHOTHERAPY, LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/04/2006
-----------------------------------------------------
Last Update Date | 04/13/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2244 95TH ST UNIT 218
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564-8033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-677-1849
-----------------------------------------------------
Fax | 630-717-1165
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2244 95TH ST UNIT 218
-----------------------------------------------------
City | NAPERVILLE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60564-8033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-677-1849
-----------------------------------------------------
Fax | 630-717-1165
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR/REGISTERED PLAY THERAPIST-
-----------------------------------------------------
Name | MRS. HEATHER L TETEAK-BERG
-----------------------------------------------------
Credential | LCPC, NCC, CCTP
-----------------------------------------------------
Telephone | 630-677-1849
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180-000428
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------