Provider Demographics
NPI:1467832907
Name:THOME, AMY M (LCPC, PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:M
Last Name:THOME
Suffix:
Gender:F
Credentials:LCPC, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 LAKE COOK RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4920
Mailing Address - Country:US
Mailing Address - Phone:312-945-1098
Mailing Address - Fax:312-275-7340
Practice Address - Street 1:770 LAKE COOK RD
Practice Address - Street 2:SUITE 270
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4920
Practice Address - Country:US
Practice Address - Phone:312-945-1098
Practice Address - Fax:312-275-7340
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-30
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009720101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional