Healthcare Provider Details

I. General information

NPI: 1053825380
Provider Name (Legal Business Name): OPTIMUM JOY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2017
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1147 W OHIO ST STE 103
CHICAGO IL
60642-5874
US

IV. Provider business mailing address

1147 W OHIO ST STE 103
CHICAGO IL
60642-5874
US

V. Phone/Fax

Practice location:
  • Phone: 312-772-9796
  • Fax:
Mailing address:
  • Phone: 312-772-9796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.010561
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA HOERR
Title or Position: PRESIDENT
Credential: LCPC
Phone: 312-772-9796