Provider Demographics
NPI:1841589462
Name:CHICAGO CENTER FOR PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:CHICAGO CENTER FOR PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:REA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-996-0699
Mailing Address - Street 1:137 N OAK PARK AVE STE 327
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1375
Mailing Address - Country:US
Mailing Address - Phone:708-848-0491
Mailing Address - Fax:
Practice Address - Street 1:137 N OAK PARK AVE STE 327
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1375
Practice Address - Country:US
Practice Address - Phone:708-848-0491
Practice Address - Fax:708-848-2876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-004882103TC0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty