Provider Demographics
NPI:1144788001
Name:INTEGRATIVE PSYCHOTHERAPY SOLUTIONS, LLC
Entity Type:Organization
Organization Name:INTEGRATIVE PSYCHOTHERAPY SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PROFESSIONAL COUN
Authorized Official - Prefix:
Authorized Official - First Name:TRACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSTROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:215-384-4000
Mailing Address - Street 1:1 E DELAWARE PL STE 310
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4962
Mailing Address - Country:US
Mailing Address - Phone:215-384-4000
Mailing Address - Fax:312-280-8365
Practice Address - Street 1:1 E DELAWARE PL STE 310
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4962
Practice Address - Country:US
Practice Address - Phone:215-384-4000
Practice Address - Fax:312-280-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180009976OtherSTATE OF IL DEPT. OF FINANCIAL AND PROFESSIONAL REG/DIVISION OF PROFESSIONAL REG