Provider Demographics
NPI:1437694254
Name:INNERSHINE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:INNERSHINE ASSOCIATES, LLC
Other - Org Name:INNERSHINE ASSOCIATES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/CLINICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCCOHNELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-218-8568
Mailing Address - Street 1:7131 S. CONSTANCE AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60649-2326
Mailing Address - Country:US
Mailing Address - Phone:312-218-8568
Mailing Address - Fax:
Practice Address - Street 1:723 W 111TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-3902
Practice Address - Country:US
Practice Address - Phone:312-218-8568
Practice Address - Fax:773-643-8649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.018437251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health