Provider Demographics
NPI:1396771697
Name:COCREATE
Entity type:Organization
Organization Name:COCREATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANN
Authorized Official - Middle Name:DAKOTA
Authorized Official - Last Name:CIMO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:773-539-9183
Mailing Address - Street 1:3850 N LAWNDALE AVE
Mailing Address - Street 2:STE 203
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-4115
Mailing Address - Country:US
Mailing Address - Phone:773-539-9183
Mailing Address - Fax:773-509-0874
Practice Address - Street 1:3850 N LAWNDALE AVE
Practice Address - Street 2:STE 203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4115
Practice Address - Country:US
Practice Address - Phone:773-539-9183
Practice Address - Fax:773-509-0874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty