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General NPI Number Information
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NPI Number | 1588163653
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Entity Type | Organization
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Legal Business Name | THREE TALES THERAPY
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Dates
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Enumeration Date | 02/05/2018
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 4800 N MILWAUKEE AVE STE 205B
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City | CHICAGO
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State | IL
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Zip | 60630-3189
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Country | US
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Telephone | 773-599-1609
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Fax |
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Provider Business Mailing Address
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Address Line | 2150 W ARTHUR AVE
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City | CHICAGO
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State | IL
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Zip | 60645-5580
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Country | US
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Telephone | 773-885-4147
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | MRS. ALEXANDRA FLIESS
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Credential |
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Telephone | 773-885-4147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.017811
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License Number State | IL
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