Healthcare Provider Details

I. General information

NPI: 1417812942
Provider Name (Legal Business Name): CHRIS PETERS THERAPY GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4043 N RAVENSWOOD AVE STE 306B
CHICAGO IL
60613-5683
US

IV. Provider business mailing address

4043 N RAVENSWOOD AVE STE 306B
CHICAGO IL
60613-5683
US

V. Phone/Fax

Practice location:
  • Phone: 323-762-5310
  • Fax:
Mailing address:
  • Phone: 323-762-5310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER PETERS
Title or Position: OWNER/CLINICAL DIRECTOR
Credential: LMFT
Phone: 323-762-5310