Provider Demographics
NPI:1558997635
Name:AVID INTIMACY, LLC
Entity Type:Organization
Organization Name:AVID INTIMACY, LLC
Other - Org Name:ESSENTIA THERAPY LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CST
Authorized Official - Phone:312-600-0409
Mailing Address - Street 1:939 W NORTH AVE STE 750
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-7142
Mailing Address - Country:US
Mailing Address - Phone:312-600-0409
Mailing Address - Fax:
Practice Address - Street 1:939 W NORTH AVE STE 750
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-7142
Practice Address - Country:US
Practice Address - Phone:312-600-0409
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-20
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty