Provider Demographics
NPI:1639120587
Name:RICK TIVERS & ASSOCIATES
Entity type:Organization
Organization Name:RICK TIVERS & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:TIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-291-0468
Mailing Address - Street 1:633 SKOKIE BLVD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2858
Mailing Address - Country:US
Mailing Address - Phone:847-291-0468
Mailing Address - Fax:847-291-0576
Practice Address - Street 1:633 SKOKIE BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2858
Practice Address - Country:US
Practice Address - Phone:847-291-0468
Practice Address - Fax:847-291-0576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1617797OtherBCBS PPO PROVIDER NUMBER
IL1617797OtherBCBS PPO PROVIDER NUMBER
IL239061Medicare ID - Type UnspecifiedSOCIAL WORKER GROUP