NPIMap

Organization Active NPI

Thriving Roots Psychological Services PLLC

  • Clinical Psychologist
  • Mokena, IL
National Provider Identifier
1649943317
Registry record updated Jul 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
Legal business name
THRIVING ROOTS PSYCHOLOGICAL SERVICES PLLC
Practice address
18700 Wolf Rd Ste 252
Mokena, IL 60448-8768
Phone
(630) 296-6784
NPI assigned
Jul 28, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2021

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

Authorized official

Name
Dr. Elizabeth PolekNPI 1225670243
Title
Owner
Phone
(630) 296-6784

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
Clinical PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103TC0700X Primary

Addresses

Primary practice location

18700 Wolf Rd Ste 252
Mokena, IL 60448-8768

Mailing address

18700 Wolf Rd Ste 252
Mokena, IL 60448-8768

National Provider Directory

National Provider Directory

Locations

18700 Wolf Rd
Ste 252
Mokena, IL 60448
Phone (630) 296-6784

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": "1627430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627430400000",
    "number": "1649943317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18700 WOLF RD STE 252",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18700 WOLF RD STE 252",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488768",
            "telephone_number": "630-296-6784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THRIVING ROOTS PSYCHOLOGICAL SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-28",
        "last_updated": "2021-07-28",
        "certification_date": "2021-07-28",
        "status": "A",
        "authorized_official_last_name": "POLEK",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-296-6784",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mokena, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2021; 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.