Provider Demographics
NPI:1689063588
Name:CONNECTED COUNSELING CHICAGO, LLC
Entity Type:Organization
Organization Name:CONNECTED COUNSELING CHICAGO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:920-988-7549
Mailing Address - Street 1:2131 W GIDDINGS ST
Mailing Address - Street 2:UNIT 3A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1494
Mailing Address - Country:US
Mailing Address - Phone:920-988-7549
Mailing Address - Fax:
Practice Address - Street 1:2131 W GIDDINGS ST
Practice Address - Street 2:UNIT 3A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-1494
Practice Address - Country:US
Practice Address - Phone:920-988-7549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0168361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty