Healthcare Provider Details

I. General information

NPI: 1083310106
Provider Name (Legal Business Name): CHICAGO INTEGRATED PSYCHOTHERAPY INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 W ALBION AVE
CHICAGO IL
60626-4613
US

IV. Provider business mailing address

1117 W ALBION AVE
CHICAGO IL
60626-4613
US

V. Phone/Fax

Practice location:
  • Phone: 773-562-6244
  • Fax: 773-562-6244
Mailing address:
  • Phone: 773-562-6244
  • Fax: 773-562-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ANUJ ANSAL
Title or Position: TREASURER
Credential: MA, LPC, CRC
Phone: 773-562-6244