Provider Demographics
NPI:1215182548
Name:GENEVIEVECONKEYTHORNTONLLC
Entity Type:Organization
Organization Name:GENEVIEVECONKEYTHORNTONLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:CONKEY
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-559-3240
Mailing Address - Street 1:899 SKOKIE BOULEVARD
Mailing Address - Street 2:204
Mailing Address - City:GLENCOE
Mailing Address - State:IL
Mailing Address - Zip Code:60062
Mailing Address - Country:US
Mailing Address - Phone:847-559-3240
Mailing Address - Fax:
Practice Address - Street 1:899 SKOKIE BLVD
Practice Address - Street 2:204
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-4019
Practice Address - Country:US
Practice Address - Phone:847-559-3240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty