Healthcare Provider Details

I. General information

NPI: 1194330993
Provider Name (Legal Business Name): COLIBRI COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 05/12/2025
Certification Date: 05/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4711 N BROADWAY ST STE 105
CHICAGO IL
60640-4908
US

IV. Provider business mailing address

4711 N BROADWAY ST STE 105
CHICAGO IL
60640-4908
US

V. Phone/Fax

Practice location:
  • Phone: 312-508-8676
  • Fax: 872-268-7990
Mailing address:
  • Phone: 312-508-8676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: HECTOR L TORRES
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 312-508-8676