MEDICARE: THREE TALES THERAPY, LLC

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	1041C0700X	Clinical Social Worker	149.017811	IL

General Provider Information

NPI Number	:	1588163653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THREE TALES THERAPY, LLC

Provider Business Mailing Address
First Line	:	4809 N RAVENSWOOD AVE STE 424
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4495
Country	:	US
Telephone Number	:	773-885-4147
Fax Number	:

Provider Business Practice Location Address
First Line	:	4809 N RAVENSWOOD AVE STE 424
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4495
Country	:	US
Telephone Number	:	773-599-1609
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORKER
Name	:	MRS. ALEXANDRA FLIESS
Credential	:
Telephone Number	:	773-885-4147

Provider Enumeration Date	:	02/05/2018
Last Update Date	:	04/21/2026

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