1285729384 NPI number — INSIGHTS PSYCHOTHERAPY, LTD.

Table of content: (NPI 1285729384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285729384 NPI number — INSIGHTS PSYCHOTHERAPY, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INSIGHTS PSYCHOTHERAPY, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285729384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2244 95TH ST UNIT 218
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60564-8033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-677-1849
Provider Business Mailing Address Fax Number:
630-717-1165

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2244 95TH ST UNIT 218
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60564-8033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-677-1849
Provider Business Practice Location Address Fax Number:
630-717-1165
Provider Enumeration Date:
10/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TETEAK-BERG
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
L
Authorized Official Title or Position:
DIRECTOR/REGISTERED PLAY THERAPIST-
Authorized Official Telephone Number:
630-677-1849

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  180-000428 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00022232187 . This is a "BLUE CROSS BLUE SHIELD OF" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".