Provider Demographics
NPI:1336795863
Name:CHICAGO LAKESHORE PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:CHICAGO LAKESHORE PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:K
Authorized Official - Last Name:HOTZE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:773-351-9239
Mailing Address - Street 1:2014 W FLETCHER ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6418
Mailing Address - Country:US
Mailing Address - Phone:773-351-9239
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 714
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7706
Practice Address - Country:US
Practice Address - Phone:773-474-2795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty