Provider Demographics
NPI:1154832913
Name:TARYN K THERAPY LLC
Entity Type:Organization
Organization Name:TARYN K THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARYN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:KONEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:872-267-4041
Mailing Address - Street 1:2500 W BRADLEY PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4716
Mailing Address - Country:US
Mailing Address - Phone:872-267-4041
Mailing Address - Fax:
Practice Address - Street 1:2500 W BRADLEY PL
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4716
Practice Address - Country:US
Practice Address - Phone:872-267-4041
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.019494261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)