NPIMap

Organization Active NPI

Affiliates in Counseling LLC

  • Clinical Psychologist
  • Northbrook, IL
National Provider Identifier
1003868472
Registry record updated Apr 27, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
AFFILIATES IN COUNSELING LLC
Practice address
633 Skokie Blvd
260
Northbrook, IL 60062-2858
Phone
(847) 480-0300
Fax
(847) 291-0576
NPI assigned
May 16, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Morton C Mirman, PH.D.NPI 1891733853
Title
Partner
Phone
(847) 480-0300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X Primary
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 106H00000X

Addresses

Primary practice location

633 Skokie Blvd
260
Northbrook, IL 60062-2858

Mailing address

910 Skokie Blvd
215
Northbrook, IL 60062-4013
Phone (847) 480-0300

Other identifiers 1

IdentifierTypeStateIssuer
1620796OtherILBCBS OF IL

Other names 1

  • The Center For Divorce Recovery Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091020000331 IL Part B Supplier - Clinic/Group Practice 1254478514 Receives reassigned benefits from 13 practitioners
Practice locations: Naperville, IL; Northbrook, IL; Chicago, IL

National Provider Directory

National Provider Directory
Tax ID family
Affiliates in Counseling LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

8080 S Harlem Ave
Ste 1
Bridgeview, IL 60455
Phone (708) 594-2700

30 N Michigan Ave
Ste 1621
Chicago, IL 60602
Phone (773) 508-4788

29 S Webster St
Ste 370
Naperville, IL 60540
Phone (847) 480-0300

535 S Washington St
Ste 7
Naperville, IL 60540
Phone (847) 480-0300

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 23

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303862400000",
    "number": "1003868472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 SKOKIE BLVD",
            "address_2": "215",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600624013",
            "telephone_number": "847-480-0300",
            "fax_number": "847-291-0576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "633 SKOKIE BLVD",
            "address_2": "260",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600622858",
            "telephone_number": "847-480-0300",
            "fax_number": "847-291-0576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFILIATES IN COUNSELING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2011-04-27",
        "status": "A",
        "authorized_official_last_name": "MIRMAN",
        "authorized_official_first_name": "MORTON",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "847-480-0300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL",
            "identifier": "1620796",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Center For Divorce Recovery",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Northbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.