NPIMap

Organization Active NPI

Tabularasa Integrative Health Inc

  • Professional Counselor
  • Gurnee, IL
National Provider Identifier
1285384248
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
TABULARASA INTEGRATIVE HEALTH INC
Practice address
135 N Greenleaf St Ste 120
Gurnee, IL 60031-3334
Phone
(224) 430-8109
NPI assigned
Mar 24, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

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

Authorized official

Name
Ms. Kim Barkus, LCPC, CADC, CCTP-IINPI 1912253659
Title
Partner
Phone
(224) 430-8109

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X Primary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X
Behavior TechnicianGroup: 193200000X MULTI-SPECIALTY GROUP 106S00000X

Addresses

Primary practice location

135 N Greenleaf St Ste 120
Gurnee, IL 60031-3334

Mailing address

135 N Greenleaf St Ste 120
Gurnee, IL 60031-3334
Phone (224) 285-0728

Other practice location 1

3060 Mercer University Dr Ste 110
Atlanta, GA 30341
Phone (224) 285-0728

Other identifiers 2

IdentifierTypeStateIssuer
1285384248MedicaidIL
342760608001MedicaidIL

Other names 1

  • TRWC Doing business as

National Provider Directory

National Provider Directory

Locations

135 N Greenleaf St
Ste 120
Gurnee, IL 60031
Phone (224) 285-0728

2255 N Green Bay Rd
Waukegan, IL 60087
Phone (847) 975-0136

Practitioners & affiliated clinicians

Practitioners 10

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": "1648080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1285384248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 N GREENLEAF ST STE 120",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600313334",
            "telephone_number": "224-285-0728",
            "fax_number": "224-249-4411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 N GREENLEAF ST STE 120",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600313334",
            "telephone_number": "224-430-8109"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3060 Mercer University Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "30341",
            "country_code": "US",
            "telephone_number": "224-285-0728",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TABULARASA INTEGRATIVE HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-24",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "BARKUS",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "224-430-8109",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCPC, CADC, CCTP-II"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285384248",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "342760608001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TRWC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "TRWC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gurnee, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2024; 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.