Provider Demographics
NPI:1831511690
Name:THE CHICAGO INTEGRATIVE CENTER FOR PSYCHIATRY LLC
Entity type:Organization
Organization Name:THE CHICAGO INTEGRATIVE CENTER FOR PSYCHIATRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-770-1241
Mailing Address - Street 1:900 NORTH SHORE DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2243
Mailing Address - Country:US
Mailing Address - Phone:847-615-1698
Mailing Address - Fax:847-615-1697
Practice Address - Street 1:900 NORTH SHORE DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2243
Practice Address - Country:US
Practice Address - Phone:847-615-1698
Practice Address - Fax:847-615-1697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36117225103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty