Provider Demographics
NPI:1083310106
Name:CHICAGO INTEGRATED PSYCHOTHERAPY INCORPORATED
Entity Type:Organization
Organization Name:CHICAGO INTEGRATED PSYCHOTHERAPY INCORPORATED
Other - Org Name:CHICAGO INTEGRATIVE PSYCHOTHERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANUJ
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSAL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, CRC
Authorized Official - Phone:773-562-6244
Mailing Address - Street 1:1117 W ALBION AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-4613
Mailing Address - Country:US
Mailing Address - Phone:773-562-6244
Mailing Address - Fax:773-562-6244
Practice Address - Street 1:4707 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-4999
Practice Address - Country:US
Practice Address - Phone:773-562-6244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty