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General NPI Number Information
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NPI Number | 1427703289
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Entity Type | Organization
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Legal Business Name | ACTIVE THERAPIES LLC
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Dates
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Enumeration Date | 02/19/2022
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 5746 N VIRGINIA AVE
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City | CHICAGO
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State | IL
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Zip | 60659-3719
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Country | US
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Telephone | 773-562-3558
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Fax |
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Provider Business Mailing Address
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Address Line | 5746 N VIRGINIA AVE
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City | CHICAGO
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State | IL
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Zip | 60659-3719
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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 | CREDENTIALING DIRECTOR
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Name | ALEX SMITH
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Credential |
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Telephone | 240-329-4959
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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