Provider Demographics
NPI:1346608718
Name:SIV CONSULTATION, LLC
Entity Type:Organization
Organization Name:SIV CONSULTATION, LLC
Other - Org Name:SIV CONSULTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:E
Authorized Official - Last Name:GORTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-905-3612
Mailing Address - Street 1:1900 S HALSTED ST
Mailing Address - Street 2:2F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3417
Mailing Address - Country:US
Mailing Address - Phone:312-905-3612
Mailing Address - Fax:
Practice Address - Street 1:820 N LASALLE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610
Practice Address - Country:US
Practice Address - Phone:312-905-3612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN071008428103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty