Healthcare Provider Details

I. General information

NPI: 1235973991
Provider Name (Legal Business Name): LINKED THERAPY IL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 N JEFFERSON ST
CHICAGO IL
60661-1226
US

IV. Provider business mailing address

6929 E 10TH ST # 194
INDIANAPOLIS IN
46219-4803
US

V. Phone/Fax

Practice location:
  • Phone: 317-207-6292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: SHELIA HALL
Title or Position: MANAGER
Credential:
Phone: 317-207-6292