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General NPI Number Information
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NPI Number | 1639585730
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Entity Type | Organization
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Legal Business Name | INTROSPECTIVE FAMILY THERAPY LLC
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Dates
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Enumeration Date | 07/09/2014
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Last Update Date | 07/09/2014
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Provider Practice Location Address
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Address Line | 3139 N LINCOLN AVE SUITE 202
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City | CHICAGO
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State | IL
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Zip | 60657-3114
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Country | US
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Telephone | 773-934-5478
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Fax |
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Provider Business Mailing Address
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Address Line | 3643 N HOYNE AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60618-4916
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Country | US
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Telephone | 773-934-5478
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Fax |
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Authorized Official
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Title or Position | MARRIAGE AND FAMILY THERAPIST
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Name | ANVIKSHA KALSCHEUR
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Credential | LMFT
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Telephone | 773-934-5478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.000710
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License Number State | IL
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