Provider Demographics
NPI:1205678679
Name:LITTLE FIRE PSYCHOTHERAPY PLLC
Entity type:Organization
Organization Name:LITTLE FIRE PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:S
Authorized Official - Last Name:GERIG
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-949-4496
Mailing Address - Street 1:4667 N MANOR AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3717
Mailing Address - Country:US
Mailing Address - Phone:224-633-3966
Mailing Address - Fax:312-748-4284
Practice Address - Street 1:4667 N MANOR AVE STE 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3717
Practice Address - Country:US
Practice Address - Phone:224-633-3966
Practice Address - Fax:312-748-4284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-07
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty