Provider Demographics
NPI:1790909513
Name:COACHING AND THERAPEUTIC INTERACTION
Entity Type:Organization
Organization Name:COACHING AND THERAPEUTIC INTERACTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PHOEBE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN HAM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:630-260-1166
Mailing Address - Street 1:705 WARRENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-6379
Mailing Address - Country:US
Mailing Address - Phone:630-260-1166
Mailing Address - Fax:630-344-1315
Practice Address - Street 1:705 WARRENVILLE RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-6379
Practice Address - Country:US
Practice Address - Phone:630-260-1166
Practice Address - Fax:630-344-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490018721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2233100OtherBCBS