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General NPI Number Information
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NPI Number | 1346608718
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Entity Type | Organization
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Legal Business Name | SIV CONSULTATION, LLC
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Dates
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Enumeration Date | 02/01/2016
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 770 N HALSTED ST STE 105
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City | CHICAGO
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State | IL
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Zip | 60642-7886
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Country | US
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Telephone | 312-298-9224
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Fax |
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Provider Business Mailing Address
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Address Line | 770 N HALSTED ST STE 105
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City | CHICAGO
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State | IL
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Zip | 60642-7886
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Country | US
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Telephone | 312-298-9224
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEBORAH ELIZABETH GORTON
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Credential |
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Telephone | 312-905-3612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 071008428
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License Number State | IN
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