Provider Demographics
NPI:1811348485
Name:TANDEM PSYCHOLOGY LLC
Entity type:Organization
Organization Name:TANDEM PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:FORTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-273-5372
Mailing Address - Street 1:3354 N PAULINA ST
Mailing Address - Street 2:205
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1068
Mailing Address - Country:US
Mailing Address - Phone:773-273-9719
Mailing Address - Fax:
Practice Address - Street 1:3354 N PAULINA ST
Practice Address - Street 2:205
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1068
Practice Address - Country:US
Practice Address - Phone:773-273-9719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-24
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008865103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty