Provider Demographics
NPI:1881615714
Name:ASSOCIATES IN MEDIATION & COUNSELING, INC.
Entity type:Organization
Organization Name:ASSOCIATES IN MEDIATION & COUNSELING, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-433-2030
Mailing Address - Street 1:1508 CANBURY CT
Mailing Address - Street 2:UNIT D-1
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-6971
Mailing Address - Country:US
Mailing Address - Phone:847-433-2030
Mailing Address - Fax:224-676-0412
Practice Address - Street 1:601 SKOKIE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2817
Practice Address - Country:US
Practice Address - Phone:847-433-2030
Practice Address - Fax:224-676-0412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-003964103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
262296OtherUBH PROVIDER ID NUMBER
IL056747OtherVALUE OPTIONS PROVIDER ID
4249359OtherAETNA PROVIDER NUMBER
MIS#458043000OtherMAGELLAN PROVIDER ID#
IL4922214OtherBLUE CROSS BLUE SHIELD IL
203646Medicare ID - Type UnspecifiedMEDICARE NUMBER