NPIMap

Organization Active NPI

Self Connected Therapy LLC

  • Adult Mental Health Clinic/Center
  • Round Lake Beach, IL
National Provider Identifier
1013521301
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
SELF CONNECTED THERAPY LLC
Practice address
2189 N. RT. 83
#292
Round Lake Beach, IL 60073
Phone
(847) 942-7849
NPI assigned
Sep 3, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

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

Authorized official

Name
Ashley Grob, LCSWNPI 1851766695
Title
Therapist
Phone
(847) 942-7849

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X Primary

Addresses

Primary practice location

2189 N. RT. 83
#292
Round Lake Beach, IL 60073

Mailing address

2189 N. RT. 83
#292
Round Lake Beach, IL 60073
Phone (847) 942-7849

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1599091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599091200000",
    "number": "1013521301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2189 N. RT. 83",
            "address_2": "#292",
            "city": "ROUND LAKE BEACH",
            "state": "IL",
            "postal_code": "60073",
            "telephone_number": "847-942-7849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2189 N. RT. 83",
            "address_2": "#292",
            "city": "ROUND LAKE BEACH",
            "state": "IL",
            "postal_code": "60073",
            "telephone_number": "847-942-7849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF CONNECTED THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-03",
        "last_updated": "2020-09-03",
        "certification_date": "2020-08-31",
        "status": "A",
        "authorized_official_last_name": "GROB",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "847-942-7849",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Round Lake Beach, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.