Provider Demographics
NPI:1043085962
Name:PERINATAL MENTAL HEALTH CENTER OF CHICAGO PLLC
Entity Type:Organization
Organization Name:PERINATAL MENTAL HEALTH CENTER OF CHICAGO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:KOST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-487-1771
Mailing Address - Street 1:3759 N RAVENSWOOD AVE STE 226C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4088
Mailing Address - Country:US
Mailing Address - Phone:312-487-1771
Mailing Address - Fax:
Practice Address - Street 1:3759 N RAVENSWOOD AVE STE 226C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4088
Practice Address - Country:US
Practice Address - Phone:312-487-1771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-21
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)