Provider Demographics
NPI:1912285834
Name:ALLIANCE COUNSELING & PSYCHOTHERAPY, LLC
Entity Type:Organization
Organization Name:ALLIANCE COUNSELING & PSYCHOTHERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANNUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-412-0872
Mailing Address - Street 1:30 N MICHIGAN AVE STE 1212
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:30 N MICHIGAN AVE STE 1212
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3731
Practice Address - Country:US
Practice Address - Phone:773-412-0872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006033103TC0700X
IL071006395103TC0700X
IL1490114301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty