Provider Demographics
NPI:1407381064
Name:INCLUSIVE INSIGHT PSYCHOTHERAPY & CONSULTING
Entity Type:Organization
Organization Name:INCLUSIVE INSIGHT PSYCHOTHERAPY & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:GRIMES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-659-9207
Mailing Address - Street 1:840 W IRVING PARK RD STE 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-3011
Mailing Address - Country:US
Mailing Address - Phone:773-659-9207
Mailing Address - Fax:773-275-3880
Practice Address - Street 1:840 W IRVING PARK RD STE 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-3011
Practice Address - Country:US
Practice Address - Phone:773-659-9207
Practice Address - Fax:773-275-3880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149009417251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health