Provider Demographics
NPI:1275277360
Name:LIMBIC SPACE
Entity Type:Organization
Organization Name:LIMBIC SPACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ART THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KAORI
Authorized Official - Middle Name:
Authorized Official - Last Name:WANDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-823-9594
Mailing Address - Street 1:231 S LASALLE ST
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604
Mailing Address - Country:US
Mailing Address - Phone:312-823-9594
Mailing Address - Fax:
Practice Address - Street 1:231 S LASALLE ST
Practice Address - Street 2:SUITE 2100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604
Practice Address - Country:US
Practice Address - Phone:312-823-9594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty