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Contact Information

RADICAL AUTHENTICITY & WELLNESS PSYCHOTHERAPY GROUP LLC
1554 W HOLLYWOOD AVE
CHICAGO, IL60660-4399
 Phone: 434-284-3806
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychologist

103T00000X 62 Psychologist, Clinical
 

Clinical

103TC0700X 62 Psychologist, Clinical
 

Counseling

103TC1900X 62 Psychologist, Clinical
Indicates primary specialty

NPI Profile & details for RADICAL AUTHENTICITY & WELLNESS PSYCHOTHERAPY GROUP LLC

NPI Number 1538875687
LBN Legal business name RADICAL AUTHENTICITY & WELLNESS PSYCHOTHERAPY GROUP LLC
Authorized official ALEXANDER TATUM - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 01/23/2023
Last updated 01/23/2023 - About 3 years ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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