Healthcare Provider Details

I. General information

NPI: 1831016377
Provider Name (Legal Business Name): TRAUMA CARE PROFESSIONALS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 N RAVENSWOOD AVE STE 101
CHICAGO IL
60640-7565
US

IV. Provider business mailing address

4611 N RAVENSWOOD AVE STE 101
CHICAGO IL
60640-7565
US

V. Phone/Fax

Practice location:
  • Phone: 773-886-3273
  • Fax:
Mailing address:
  • Phone: 773-886-3273
  • 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 Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. DEREK R HENKLE
Title or Position: CLINICAL PROFESSIONAL COUNSELOR
Credential: LCPC
Phone: 773-886-3273