NPIMap

Organization Active NPI

Lifepath Therapy Associates, LLC

  • Clinical Social Worker
  • Chicago, IL
National Provider Identifier
1629636394
Registry record updated May 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
LIFEPATH THERAPY ASSOCIATES, LLC
Practice address
25 E Washington St Ste 1837
Chicago, IL 60602-1708
Phone
(773) 413-9389
NPI assigned
May 29, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2019

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

Authorized official

Name
Kimberly Vander Griend, LCSWNPI 1578839528
Title
Co-Owner/Psychotherapist
Phone
(773) 413-8389

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
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X Primary
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X

Addresses

Primary practice location

25 E Washington St Ste 1837
Chicago, IL 60602-1708

Mailing address

25 E Washington St Ste 910
Chicago, IL 60602-1717
Phone (773) 413-9389

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200616001534 IL Part B Supplier - Clinic/Group Practice 7911333703 Receives reassigned benefits from 13 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

25 E Washington St
Ste 1837
Chicago, IL 60602
Phone (773) 413-9389

25 E Washington St
Ste 1835
Chicago, IL 60602
Phone (312) 940-3655

Practitioners & affiliated clinicians

Practitioners 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1559088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1559088000000",
    "number": "1629636394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 E WASHINGTON ST STE 910",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606021717",
            "telephone_number": "773-413-9389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 E WASHINGTON ST STE 1837",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606021708",
            "telephone_number": "773-413-9389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEPATH THERAPY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-29",
        "last_updated": "2019-05-29",
        "status": "A",
        "authorized_official_last_name": "VANDER GRIEND",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CO-OWNER/PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "773-413-8389",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2019; 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.