MEDICARE: CYPRESSHOLISTIC PSYCHIATRY

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1255280004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYPRESSHOLISTIC PSYCHIATRY

Provider Business Mailing Address
First Line	:	1449 S MICHIGAN AVE STE 13354
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60605-2810
Country	:	US
Telephone Number	:	312-313-2710
Fax Number	:	312-386-5539

Provider Business Practice Location Address
First Line	:	3440 N LAKE SHORE DR
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-2818
Country	:	US
Telephone Number	:	312-313-2710
Fax Number	:	312-386-5539

Authorized Official
Title or Position	:	CEO/FOUNDER
Name	:	CHIQUE HENDERSON
Credential	:	APRN, PMHNP-BC
Telephone Number	:	312-523-4988

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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