Provider Demographics
NPI:1154708899
Name:INSTITUTE FOR THERAPY THROUGH THE ARTS
Entity type:Organization
Organization Name:INSTITUTE FOR THERAPY THROUGH THE ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICA
Authorized Official - Middle Name:MELANIE
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-425-9708
Mailing Address - Street 1:1316 SHERMAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4361
Mailing Address - Country:US
Mailing Address - Phone:847-425-9708
Mailing Address - Fax:847-448-8337
Practice Address - Street 1:1316 SHERMAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4361
Practice Address - Country:US
Practice Address - Phone:847-425-9708
Practice Address - Fax:847-448-8337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-01
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt TherapistGroup - Multi-Specialty
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance TherapistGroup - Multi-Specialty
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00621OtherBLUE CROSS BLUE SHIELD OF ILLINOIS
RISB870OtherBLUE CROSS BLUE SHIELD OF RHODE ISLAND
IL60054OtherAETNA
CABS001OtherBLUE CROSS BLUE SHIELD OF CALIFORNIA