Provider Demographics
NPI:1225336555
Name:FOCHT FAMILY PRACTICE
Entity Type:Organization
Organization Name:FOCHT FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:FOCHT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:312-470-6938
Mailing Address - Street 1:226 W SAINT PAUL AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-8911
Mailing Address - Country:US
Mailing Address - Phone:312-470-6938
Mailing Address - Fax:312-280-8365
Practice Address - Street 1:1 E DELAWARE PL
Practice Address - Street 2:SUITE 310
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-1449
Practice Address - Country:US
Practice Address - Phone:312-470-6938
Practice Address - Fax:312-280-8365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL27-4560033106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty