Provider Demographics
NPI:1841759420
Name:PARENT CHILD CATALYST LLC
Entity Type:Organization
Organization Name:PARENT CHILD CATALYST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDMUNDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-505-1967
Mailing Address - Street 1:3047 N LINCOLN AVE UNIT 400
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4274
Mailing Address - Country:US
Mailing Address - Phone:773-505-1967
Mailing Address - Fax:
Practice Address - Street 1:3047 N LINCOLN AVE UNIT 400
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4274
Practice Address - Country:US
Practice Address - Phone:773-505-1967
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-13
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty