Provider Demographics
NPI:1144869173
Name:COGNITIVE BEHAVIORAL GROWTH, LLC
Entity type:Organization
Organization Name:COGNITIVE BEHAVIORAL GROWTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST, FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:HINCKLEY
Authorized Official - Last Name:BERGHORST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-888-4422
Mailing Address - Street 1:939 W NORTH AVE STE 875
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-7146
Mailing Address - Country:US
Mailing Address - Phone:773-888-4422
Mailing Address - Fax:
Practice Address - Street 1:939 W NORTH AVE STE 875
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-7146
Practice Address - Country:US
Practice Address - Phone:773-888-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-20
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty