Provider Demographics
NPI:1164003190
Name:CHICAGO NERD THERAPY, PLLC
Entity Type:Organization
Organization Name:CHICAGO NERD THERAPY, PLLC
Other - Org Name:CHICAGO NERD THERAPY, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-270-0098
Mailing Address - Street 1:4306 N LINCOLN AVE UNIT 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1712
Mailing Address - Country:US
Mailing Address - Phone:312-270-0098
Mailing Address - Fax:
Practice Address - Street 1:5230 N MOBILE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-1010
Practice Address - Country:US
Practice Address - Phone:312-270-0098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health