Healthcare Provider Details

I. General information

NPI: 1023328275
Provider Name (Legal Business Name): HIGGINS & CARTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 W. JACKSON BLVD STE 1257
CHICAGO IL
60604
US

IV. Provider business mailing address

53 W. JACKSON BLVD STE 1257
CHICAGO IL
60604
US

V. Phone/Fax

Practice location:
  • Phone: 312-360-1983
  • Fax: 312-360-1984
Mailing address:
  • Phone: 312-360-1983
  • Fax: 312-360-1984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180007557
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149014243
License Number StateIL

VIII. Authorized Official

Name: MR. RYAN J HIGGINS
Title or Position: CO-FOUNDER
Credential: LCPC
Phone: 312-360-1983