1881615714 NPI number — ASSOCIATES IN MEDIATION & COUNSELING, INC.

Table of content: (NPI 1881615714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881615714 NPI number — ASSOCIATES IN MEDIATION & COUNSELING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSOCIATES IN MEDIATION & COUNSELING, INC.
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:
CHERYL SPIELMAN, PSY.D.
Provider Other Organization Name Type Code:
5
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:
1881615714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1508 CANBURY CT
Provider Second Line Business Mailing Address:
UNIT D-1
Provider Business Mailing Address City Name:
WHEELING
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60090-6971
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-433-2030
Provider Business Mailing Address Fax Number:
224-676-0412

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 SKOKIE BLVD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHBROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60062-2817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-433-2030
Provider Business Practice Location Address Fax Number:
224-676-0412
Provider Enumeration Date:
07/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPIELMAN
Authorized Official First Name:
CHERYL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT, CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
847-433-2030

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  071-003964 , 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: 262296 . This is a "UBH PROVIDER ID NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 056747 . This is a "VALUE OPTIONS PROVIDER ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 4249359 . This is a "AETNA PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: MIS#458043000 . This is a "MAGELLAN PROVIDER ID#" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4922214 . This is a "BLUE CROSS BLUE SHIELD IL" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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