Provider Demographics
NPI:1538756705
Name:AUTHENTIC INSIGHT CENTER FOR EMOTIONAL HEALTH PLLC
Entity type:Organization
Organization Name:AUTHENTIC INSIGHT CENTER FOR EMOTIONAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANASTASIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCANGAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:733-691-3681
Mailing Address - Street 1:4850 N MEADE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2902
Mailing Address - Country:US
Mailing Address - Phone:773-691-3681
Mailing Address - Fax:
Practice Address - Street 1:4609 N SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-5019
Practice Address - Country:US
Practice Address - Phone:773-691-3681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-22
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL149021395OtherSTATE OF ILLINOIS