Provider Demographics
NPI:1801284799
Name:CHICAGO CENTER FOR EVIDENCE BASED TREATMENT, LLC
Entity type:Organization
Organization Name:CHICAGO CENTER FOR EVIDENCE BASED TREATMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-600-3936
Mailing Address - Street 1:25 E WASHINGTON ST STE 826
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-1799
Mailing Address - Country:US
Mailing Address - Phone:312-600-3936
Mailing Address - Fax:312-600-3936
Practice Address - Street 1:25 E WASHINGTON ST STE 826
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-1799
Practice Address - Country:US
Practice Address - Phone:312-600-3936
Practice Address - Fax:312-600-3936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149014532261QM0850X, 261QM0855X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health