Provider Demographics
NPI:1528532785
Name:AKSPAINLLC
Entity type:Organization
Organization Name:AKSPAINLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANURADHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MA LCSW
Authorized Official - Phone:630-240-1182
Mailing Address - Street 1:245 S EAST AVE UNIT 1
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3211
Mailing Address - Country:US
Mailing Address - Phone:630-240-1182
Mailing Address - Fax:
Practice Address - Street 1:245 S EAST AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-3211
Practice Address - Country:US
Practice Address - Phone:630-240-1182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-21
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health