Provider Demographics
NPI:1811657513
Name:ARIADNE COUNSELING SERVICES
Entity type:Organization
Organization Name:ARIADNE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:POYESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GANJI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:541-905-0893
Mailing Address - Street 1:2544 W CORTEZ ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-3444
Mailing Address - Country:US
Mailing Address - Phone:541-905-0894
Mailing Address - Fax:
Practice Address - Street 1:2544 W CORTEZ ST APT 2F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-3444
Practice Address - Country:US
Practice Address - Phone:541-905-0894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-21
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health