Healthcare Provider Details

I. General information

NPI: 1700558830
Provider Name (Legal Business Name): UDISHA BHADURY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2021
Last Update Date: 09/28/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N MICHIGAN AVE STE 1400
CHICAGO IL
60601-4011
US

IV. Provider business mailing address

365 N HALSTED ST APT 1917
CHICAGO IL
60661-1376
US

V. Phone/Fax

Practice location:
  • Phone: 312-235-1999
  • Fax:
Mailing address:
  • Phone: 832-888-5477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.017332
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: