Provider Demographics
NPI:1336887348
Name:CLK PSYCHOTHERAPY PLLC
Entity Type:Organization
Organization Name:CLK PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARY
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:KLEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:773-231-8407
Mailing Address - Street 1:6201 N WAYNE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1916
Mailing Address - Country:US
Mailing Address - Phone:773-231-8407
Mailing Address - Fax:
Practice Address - Street 1:6201 N WAYNE AVE APT 3
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1916
Practice Address - Country:US
Practice Address - Phone:773-231-8407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-20
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health