Provider Demographics
NPI:1114342599
Name:WILDFLOWER CENTER FOR EMOTIONAL HEALTH PLLC
Entity Type:Organization
Organization Name:WILDFLOWER CENTER FOR EMOTIONAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-809-0298
Mailing Address - Street 1:820 N ORLEANS ST STE 350
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-3145
Mailing Address - Country:US
Mailing Address - Phone:312-809-0298
Mailing Address - Fax:
Practice Address - Street 1:820 N ORLEANS ST STE 350
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-3145
Practice Address - Country:US
Practice Address - Phone:312-809-0298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-21
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490143731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty