Radical Authenticity & Wellness Psychotherapy Group LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

RADICAL AUTHENTICITY & WELLNESS PSYCHOTHERAPY GROUP LLC

Practice address

1554 W Hollywood Ave
Chicago, IL 60660-4399

Phone

(434) 284-3806

NPI assigned

Jan 23, 2023

Last updated

Jan 23, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alexander K Tatum, PHDNPI 1316435423

Title

President

Phone

(434) 284-3806

Specialties & licenses 3

Addresses

Practitioners 1

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.

• Alexander Kyle Tatum

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1316435423
  NPD Authorized official

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

{
    "created_epoch": "1674432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674432000000",
    "number": "1538875687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5754 N WINTHROP AVE APT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606605148",
            "telephone_number": "434-284-3806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1554 W HOLLYWOOD AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606604399",
            "telephone_number": "434-284-3806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADICAL AUTHENTICITY & WELLNESS PSYCHOTHERAPY GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-23",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A",
        "authorized_official_last_name": "TATUM",
        "authorized_official_first_name": "ALEXANDER",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "434-284-3806",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• George A Radich, MD

• Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; 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.