=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467312603
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEONY PATH PSYCHOTHERAPY PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2025
-----------------------------------------------------
Last Update Date | 12/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 E HURON ST STE 320
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60611-5244
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-340-1361
-----------------------------------------------------
Fax | 312-999-0733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 790 ESTATE DR STE 200
-----------------------------------------------------
City | DEERFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60015-4879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-340-1361
-----------------------------------------------------
Fax | 312-999-0733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER AND COMPLEX TRAUMA THERAPIST
-----------------------------------------------------
Name | SARAH VASSILEFF
-----------------------------------------------------
Credential | MA, LCPC
-----------------------------------------------------
Telephone | 224-475-3490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------