Provider Demographics
NPI:1598535502
Name:ONE BREATH AT A TIME COUNSELING, PLLC
Entity Type:Organization
Organization Name:ONE BREATH AT A TIME COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:DIEDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC
Authorized Official - Phone:312-833-0655
Mailing Address - Street 1:6347 N WAYNE AVE APT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1611
Mailing Address - Country:US
Mailing Address - Phone:312-833-0655
Mailing Address - Fax:
Practice Address - Street 1:6347 N WAYNE AVE APT 2N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1611
Practice Address - Country:US
Practice Address - Phone:312-833-0655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty