Healthcare Provider Details

I. General information

NPI: 1134062821
Provider Name (Legal Business Name): CHICAGO COUNSELING CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 N CICERO AVE STE 630
CHICAGO IL
60646-4325
US

IV. Provider business mailing address

6140 N KILBOURN AVE
CHICAGO IL
60646-5020
US

V. Phone/Fax

Practice location:
  • Phone: 773-932-9597
  • Fax: 773-243-0519
Mailing address:
  • Phone: 773-932-9597
  • Fax: 773-453-0519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. TAYLOR K NEWENDORP
Title or Position: OWNER/PRESIDENT
Credential: MA, LCPC
Phone: 773-932-9597