Provider Demographics
NPI:1134938251
Name:INTENTIONAL RELATIONSHIP THERAPY LLC
Entity type:Organization
Organization Name:INTENTIONAL RELATIONSHIP THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAKISHA
Authorized Official - Middle Name:CARLA
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:224-408-0156
Mailing Address - Street 1:872 S MILWAUKEE AVE STE 79
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3227
Mailing Address - Country:US
Mailing Address - Phone:224-408-0156
Mailing Address - Fax:
Practice Address - Street 1:721 CALIENTE CT
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5222
Practice Address - Country:US
Practice Address - Phone:224-408-0156
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-03
Last Update Date:2025-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty