Provider Demographics
NPI:1912328212
Name:CENTERED THERAPY CHICAGO PLLC
Entity Type:Organization
Organization Name:CENTERED THERAPY CHICAGO PLLC
Other - Org Name:CENTERED THERAPY CHICAGO LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BIANKA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-569-1426
Mailing Address - Street 1:1507 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3067
Mailing Address - Country:US
Mailing Address - Phone:773-569-1468
Mailing Address - Fax:
Practice Address - Street 1:4050 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3067
Practice Address - Country:US
Practice Address - Phone:773-569-1426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-04
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty