MEDICARE: CENTERED MIND PSYCHOTHERAPY, 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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1669135307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERED MIND PSYCHOTHERAPY, PLLC

Provider Business Mailing Address
First Line	:	53 W JACKSON BLVD STE 1334
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-3548
Country	:	US
Telephone Number	:	312-925-0194
Fax Number	:

Provider Business Practice Location Address
First Line	:	53 W JACKSON BLVD STE 1334
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60604-3548
Country	:	US
Telephone Number	:	312-725-0194
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL PSYCHOLOGIST
Name	:	DR. KATHLEEN K. EMERY
Credential	:	PHD
Telephone Number	:	312-925-0194

Provider Enumeration Date	:	10/19/2021
Last Update Date	:	10/19/2021

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