Healthcare Provider Details

I. General information

NPI: 1578333902
Provider Name (Legal Business Name): INNER CHOICE PSYCHOTHERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5547 N RAVENSWOOD AVE STE 407
CHICAGO IL
60640-1125
US

IV. Provider business mailing address

5547 N RAVENSWOOD AVE STE 407
CHICAGO IL
60640-1125
US

V. Phone/Fax

Practice location:
  • Phone: 312-806-8854
  • Fax:
Mailing address:
  • Phone: 312-806-8854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANNABETH CHICKERING
Title or Position: FOUNDER/PSYCHOTHERAPIST
Credential: LCPC
Phone: 312-806-8854