Provider Demographics
NPI:1629738968
Name:BESPOKE HEALING PLLC
Entity Type:Organization
Organization Name:BESPOKE HEALING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ALLAYNA FERN
Authorized Official - Middle Name:
Authorized Official - Last Name:PINKSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-690-3140
Mailing Address - Street 1:5153 N CLARK ST STE 306
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-6850
Mailing Address - Country:US
Mailing Address - Phone:312-690-3140
Mailing Address - Fax:
Practice Address - Street 1:5153 N CLARK ST STE 306
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-6850
Practice Address - Country:US
Practice Address - Phone:312-690-3140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-28
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1760931695OtherTYPE I NPI