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General NPI Number Information
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NPI Number | 1649901125
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Entity Type | Organization
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Legal Business Name | THIRD EDGE LLC
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 175 CARTHAGE LN
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-1823
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Country | US
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Telephone | 847-208-3802
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Fax |
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Provider Business Mailing Address
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Address Line | 175 CARTHAGE LN
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City | HOFFMAN ESTATES
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State | IL
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Zip | 60169-1823
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Country | US
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Telephone | 847-208-3802
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Fax |
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Authorized Official
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Title or Position | CEO AND PSYCHOTHERAPIST
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Name | MONICA N MIKHAEIL
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Credential | MA, LPC, NCC
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Telephone | 847-208-3802
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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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