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General NPI Number Information
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NPI Number | 1487901609
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Entity Type | Individual
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Provider Name | ANNA R BASOV PSYD, LCPC
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Gender | Female
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 10/28/2015
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Provider Practice Location Address
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Address Line | 601 SKOKIE BLVD SUITE #LL-5D
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City | NORTHBROOK
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State | IL
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Zip | 60062-2851
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Country | US
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Telephone | 847-607-1589
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Fax | 847-881-0839
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Provider Business Mailing Address
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Address Line | 601 SKOKIE BOULEVARD SUITE #LL-5D
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City | NORTHBROOK
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State | IL
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Zip | 60060-2813
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Country | US
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Telephone | 847-607-1589
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Fax | 847-881-0839
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.009063
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178.007955
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071009153
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License Number State | IL
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