Provider Demographics
NPI:1881130748
Name:DARA DENTON LLC
Entity type:Organization
Organization Name:DARA DENTON LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DARA
Authorized Official - Middle Name:JEFFERS
Authorized Official - Last Name:DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:612-723-1518
Mailing Address - Street 1:53 W. JACKSON BLVD
Mailing Address - Street 2:SUITE 604
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3606
Mailing Address - Country:US
Mailing Address - Phone:612-444-1947
Mailing Address - Fax:612-314-8570
Practice Address - Street 1:53 W. JACKSON BLVD
Practice Address - Street 2:SUITE 604
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3606
Practice Address - Country:US
Practice Address - Phone:612-444-1947
Practice Address - Fax:612-314-8570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-16
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009738101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty