Provider Demographics
NPI:1467568949
Name:AFFIRMING ALTERNATIVES PSYCHOLOGICAL SERVICES, PC
Entity Type:Organization
Organization Name:AFFIRMING ALTERNATIVES PSYCHOLOGICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-381-1922
Mailing Address - Street 1:1348 W GLENLAKE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-2506
Mailing Address - Country:US
Mailing Address - Phone:773-381-1922
Mailing Address - Fax:
Practice Address - Street 1:1348 W GLENLAKE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-2506
Practice Address - Country:US
Practice Address - Phone:773-381-1922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210324Medicare ID - Type Unspecified