Provider Demographics
NPI:1710432042
Name:JKOROTKO COUNSELING AND ART THERAPY PC
Entity Type:Organization
Organization Name:JKOROTKO COUNSELING AND ART THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST AND FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:CORINNE
Authorized Official - Last Name:KOROTKO
Authorized Official - Suffix:
Authorized Official - Credentials:ATR, LCPC
Authorized Official - Phone:773-683-2781
Mailing Address - Street 1:2858 W DIVERSEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-1871
Mailing Address - Country:US
Mailing Address - Phone:773-683-2781
Mailing Address - Fax:
Practice Address - Street 1:2858 W DIVERSEY AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60647-1871
Practice Address - Country:US
Practice Address - Phone:773-683-2781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty