1225809239 NPI number — SYNCHRONICITY COUNSELING SERVICES, LLC

Table of content: DR. TIMOTHY PAUL MARTENS MD (NPI 1053554550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225809239 NPI number — SYNCHRONICITY COUNSELING SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYNCHRONICITY COUNSELING SERVICES, LLC
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:
1225809239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
661 W LAKE ST
Provider Second Line Business Mailing Address:
STE 2S
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60661-1034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-324-4838
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
661 W LAKE ST
Provider Second Line Business Practice Location Address:
STE 2S
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60661-1034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-324-4838
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2024

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
KATHERINE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
312-324-4838

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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