Provider Demographics
NPI:1588232334
Name:EMILY GRAYSON PSYCHOTHERAPY
Entity Type:Organization
Organization Name:EMILY GRAYSON PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:LENORE
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-702-4845
Mailing Address - Street 1:729 EMERSON ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-3836
Mailing Address - Country:US
Mailing Address - Phone:847-702-4845
Mailing Address - Fax:
Practice Address - Street 1:1040 WESLEY AVE
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201
Practice Address - Country:UM
Practice Address - Phone:847-702-4845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty