Provider Demographics
NPI:1144686122
Name:FREESTONE PSYCHOTHERAPY LLC
Entity type:Organization
Organization Name:FREESTONE PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-834-7778
Mailing Address - Street 1:4619 N RAVENSWOOD AVE
Mailing Address - Street 2:SUITE 303C
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-4580
Mailing Address - Country:US
Mailing Address - Phone:312-834-7778
Mailing Address - Fax:
Practice Address - Street 1:4619 N RAVENSWOOD AVE
Practice Address - Street 2:SUITE 303C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4580
Practice Address - Country:US
Practice Address - Phone:312-834-7778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490157721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty