Provider Demographics
NPI:1366013054
Name:INTERCULTURAL BEHAVIORAL HEALTH & CONSULTATION LLC
Entity Type:Organization
Organization Name:INTERCULTURAL BEHAVIORAL HEALTH & CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AYAKO
Authorized Official - Middle Name:
Authorized Official - Last Name:KONNO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:312-545-8480
Mailing Address - Street 1:155 N MICHIGAN AVE STE 569
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7799
Mailing Address - Country:US
Mailing Address - Phone:312-545-8480
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 569
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7799
Practice Address - Country:US
Practice Address - Phone:312-545-8480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty