Provider Demographics
NPI:1902453921
Name:PHILIP BESTROM PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:PHILIP BESTROM PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:BESTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:872-333-9803
Mailing Address - Street 1:2545 S DEARBORN ST APT 511
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4986
Mailing Address - Country:US
Mailing Address - Phone:203-610-9248
Mailing Address - Fax:
Practice Address - Street 1:180 N MICHIGAN AVE STE 1910B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7401
Practice Address - Country:US
Practice Address - Phone:873-333-9803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty