Healthcare Provider Details

I. General information

NPI: 1114406873
Provider Name (Legal Business Name): CHICAGO PRIDE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4809 N RAVENSWOOD AVE UNIT 210
CHICAGO IL
60640-4417
US

IV. Provider business mailing address

7637 N BOSWORTH AVE
CHICAGO IL
60626-7159
US

V. Phone/Fax

Practice location:
  • Phone: 773-334-3533
  • Fax:
Mailing address:
  • Phone: 773-319-4325
  • Fax: 773-439-5683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MR. HUGH COLE
Title or Position: CFO
Credential: LCSW
Phone: 773-334-3533