Healthcare Provider Details

I. General information

NPI: 1083299572
Provider Name (Legal Business Name): LIFESPAN BEHAVIORAL HEALTH P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 N CLARK ST STE 212
CHICAGO IL
60614-1850
US

IV. Provider business mailing address

2502 N CLARK ST STE 212
CHICAGO IL
60614-1850
US

V. Phone/Fax

Practice location:
  • Phone: 773-930-9553
  • Fax:
Mailing address:
  • Phone: 773-930-9553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW HARINGS
Title or Position: CEO
Credential: PSY.D.
Phone: 773-930-9553