Provider Demographics
NPI:1124346168
Name:INTRASPECTRUM COUNSELING, LTD.
Entity type:Organization
Organization Name:INTRASPECTRUM COUNSELING, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAYLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:847-363-5088
Mailing Address - Street 1:180 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 2421
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7401
Mailing Address - Country:US
Mailing Address - Phone:847-363-5088
Mailing Address - Fax:773-961-8804
Practice Address - Street 1:180 N MICHIGAN AVE
Practice Address - Street 2:SUITE 2421
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7401
Practice Address - Country:US
Practice Address - Phone:847-363-5088
Practice Address - Fax:773-961-8804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-15
Last Update Date:2010-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007587103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty