=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821532490
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXA D EHRLICH AMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2016
-----------------------------------------------------
Last Update Date | 02/01/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 W ADAMS ST STE 410
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60606-5108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-578-9990
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 637 N WELLS ST APT 2212
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60654-3789
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-918-0298
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 208.000562
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------