Organization
PARK RIDGE COUNSELING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TARA GIDNEY THOMPSON PSYD (PARTNER/OWNER)
(847) 722-5967
Entity
Organization
Contact information
Practice address
350 S. NORTHWEST HIGHWAY, SUITE 300, PARK RIDGE, IL 60068
(847) 722-5967
Mailing address
350 S. NORTHWEST HIGHWAY, SUITE 300, PARK RIDGE, IL 60068
(847) 722-5967
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071007131
IL
302F00000X
Exclusive Provider Organization
071.007131
IL
302R00000X
Health Maintenance Organization
071.007131
IL
305R00000X
Preferred Provider Organization
071.007131
IL
305S00000X
Point of Service
071.007131
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208217065
—
IL
05
—
261553352
—
IL
Enumeration date
04/25/2008
Last updated
09/24/2008
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