Provider Demographics
NPI:1760118590
Name:HIGHWIRE THERAPY, LLC
Entity Type:Organization
Organization Name:HIGHWIRE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:BYRNES
Authorized Official - Last Name:STAIGER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-870-3553
Mailing Address - Street 1:3501 N SOUTHPORT AVE UNIT 145
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-1475
Mailing Address - Country:US
Mailing Address - Phone:773-870-3553
Mailing Address - Fax:
Practice Address - Street 1:3501 N SOUTHPORT AVE UNIT 145
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1475
Practice Address - Country:US
Practice Address - Phone:773-870-3553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health