MEDICARE: UNTETHER THERAPY LLC

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	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1306790985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNTETHER THERAPY LLC

Provider Business Mailing Address
First Line	:	1440 W TAYLOR ST STE 1437
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 S HOYNE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1110
Country	:	US
Telephone Number	:	708-712-1323
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TEENA PUROHIT
Credential	:	LCSW
Telephone Number	:	708-712-1323

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	04/06/2026

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Directions to “UNTETHER THERAPY LLC ” Practice Location

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