Provider Demographics
NPI:1891238986
Name:SIV CONSULTATION
Entity Type:Organization
Organization Name:SIV CONSULTATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GORTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-905-3612
Mailing Address - Street 1:319 S JEFFERSON ST
Mailing Address - Street 2:2F
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-5616
Mailing Address - Country:US
Mailing Address - Phone:312-905-3612
Mailing Address - Fax:
Practice Address - Street 1:820 N LA SALLE DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3214
Practice Address - Country:US
Practice Address - Phone:312-883-4077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.012542101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty