Provider Demographics
NPI:1295082295
Name:SPRINGTIDES, INC.
Entity type:Organization
Organization Name:SPRINGTIDES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:SZWALEK
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-282-2610
Mailing Address - Street 1:2400 N LAKEVIEW AVE
Mailing Address - Street 2:#1703
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2739
Mailing Address - Country:US
Mailing Address - Phone:312-282-2610
Mailing Address - Fax:
Practice Address - Street 1:2400 N LAKEVIEW AVE
Practice Address - Street 2:#1703
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2739
Practice Address - Country:US
Practice Address - Phone:312-282-2610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008213101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty