Provider Demographics
NPI:1275789364
Name:INTROSPECT COUNSELING SERVICES
Entity Type:Organization
Organization Name:INTROSPECT COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ERES
Authorized Official - Middle Name:
Authorized Official - Last Name:RAPREE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-954-1678
Mailing Address - Street 1:1819 BRUMMEL ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3739
Mailing Address - Country:US
Mailing Address - Phone:773-954-1678
Mailing Address - Fax:847-475-4541
Practice Address - Street 1:1609 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-3753
Practice Address - Country:US
Practice Address - Phone:773-954-1678
Practice Address - Fax:847-475-4541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005071101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty