MEDICARE: PEONY PATH PSYCHOTHERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1467312603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEONY PATH PSYCHOTHERAPY PLLC

Provider Business Mailing Address
First Line	:	790 ESTATE DR STE 200
Second Line	:
City	:	DEERFIELD
State	:	IL
Zip	:	60015-4879
Country	:	US
Telephone Number	:	773-340-1361
Fax Number	:	312-999-0733

Provider Business Practice Location Address
First Line	:	40 E HURON ST STE 320
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-5244
Country	:	US
Telephone Number	:	773-340-1361
Fax Number	:	312-999-0733

Authorized Official
Title or Position	:	OWNER AND COMPLEX TRAUMA THERAPIST
Name	:	SARAH VASSILEFF
Credential	:	MA, LCPC
Telephone Number	:	224-475-3490

Provider Enumeration Date	:	11/12/2025
Last Update Date	:	12/02/2025

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