Provider Demographics
NPI:1659696185
Name:CBT CLINIC OF CHICAGO, P.C.
Entity Type:Organization
Organization Name:CBT CLINIC OF CHICAGO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-228-4200
Mailing Address - Street 1:180 N STETSON AVE
Mailing Address - Street 2:SUITE 3150
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-6710
Mailing Address - Country:US
Mailing Address - Phone:312-228-4200
Mailing Address - Fax:312-540-1231
Practice Address - Street 1:180 N STETSON AVE
Practice Address - Street 2:SUITE 3150
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-6710
Practice Address - Country:US
Practice Address - Phone:312-228-4200
Practice Address - Fax:312-540-1231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-26
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007344103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty