Provider Demographics
NPI:1265737258
Name:CHICAGO PSYCHOTHERAPY AND CONSULTING, LLC
Entity type:Organization
Organization Name:CHICAGO PSYCHOTHERAPY AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PROFESSIONAL COUSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KERRIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-654-2420
Mailing Address - Street 1:3047 N LINCOLN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-4999
Mailing Address - Country:US
Mailing Address - Phone:773-654-2420
Mailing Address - Fax:
Practice Address - Street 1:3047 N LINCOLN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-4999
Practice Address - Country:US
Practice Address - Phone:773-654-2420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL201663803101YP2500X
IL071006768103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty