Healthcare Provider Details

I. General information

NPI: 1659696185
Provider Name (Legal Business Name): CBT CLINIC OF CHICAGO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2010
Last Update Date: 03/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N STETSON AVE SUITE 3150
CHICAGO IL
60601-6710
US

IV. Provider business mailing address

180 N STETSON AVE SUITE 3150
CHICAGO IL
60601-6710
US

V. Phone/Fax

Practice location:
  • Phone: 312-228-4200
  • Fax: 312-540-1231
Mailing address:
  • Phone: 312-228-4200
  • Fax: 312-540-1231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number071007344
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071007344
License Number StateIL

VIII. Authorized Official

Name: DR. ELISE D MASSIE
Title or Position: OWNER
Credential: PH.D.
Phone: 312-228-4200