MEDICARE: JAMIE TUBBS THERAPY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1164372660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMIE TUBBS THERAPY, PLLC

Provider Business Mailing Address
First Line	:	1104 S MASON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-5340
Country	:	US
Telephone Number	:	312-550-2922
Fax Number	:	312-550-2922

Provider Business Practice Location Address
First Line	:	1104 S MASON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60644-5340
Country	:	US
Telephone Number	:	312-550-2922
Fax Number	:	312-550-2922

Authorized Official
Title or Position	:	THERAPIST
Name	:	JAMIE TUBBS
Credential	:	LCSW
Telephone Number	:	312-550-2922

Provider Enumeration Date	:	02/02/2026
Last Update Date	:	02/02/2026

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