Provider Demographics
NPI:1982332243
Name:BABA YAGA THERAPY PLLC
Entity Type:Organization
Organization Name:BABA YAGA THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KYRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEUBEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-234-2898
Mailing Address - Street 1:3452 N AVERS AVE APT 3R
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-5214
Mailing Address - Country:US
Mailing Address - Phone:773-234-2898
Mailing Address - Fax:
Practice Address - Street 1:3452 N AVERS AVE APT 3R
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5214
Practice Address - Country:US
Practice Address - Phone:773-234-2898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-12
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty