Provider Demographics
NPI:1346789658
Name:THERAPY APP
Entity Type:Organization
Organization Name:THERAPY APP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:NOLAN
Authorized Official - Last Name:CHICOSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-873-7617
Mailing Address - Street 1:1651 W CENTRE AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-6312
Mailing Address - Country:US
Mailing Address - Phone:269-873-7617
Mailing Address - Fax:
Practice Address - Street 1:1651 W CENTRE AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-6312
Practice Address - Country:US
Practice Address - Phone:269-873-7617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YP2500X, 103G00000X, 103TB0200X, 103TC1900X, 103TP2701X, 106H00000X
MI68010901711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty