Provider Demographics
NPI:1578335006
Name:CHICAGO CENTER FOR GROWTH AND CHANGE CONCIERGE THERAPY, LLC
Entity Type:Organization
Organization Name:CHICAGO CENTER FOR GROWTH AND CHANGE CONCIERGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:ERIN
Authorized Official - Last Name:SINGER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:872-701-0748
Mailing Address - Street 1:4815 W STRONG ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2415
Mailing Address - Country:US
Mailing Address - Phone:872-701-0748
Mailing Address - Fax:
Practice Address - Street 1:25 E WASHINGTON ST STE 1717
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1839
Practice Address - Country:US
Practice Address - Phone:872-701-0748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty