Healthcare Provider Details

I. General information

NPI: 1366397382
Provider Name (Legal Business Name): CRYSTAL THOMAS, PSYCHOTHERAPIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 N DAMEN AVE APT 3W
CHICAGO IL
60625-1341
US

IV. Provider business mailing address

5055 N DAMEN AVE APT 3W
CHICAGO IL
60625-1341
US

V. Phone/Fax

Practice location:
  • Phone: 312-995-9612
  • Fax:
Mailing address:
  • Phone: 312-995-9612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CRYSTALANN SASHA THOMAS
Title or Position: MANAGER
Credential: LCSW
Phone: 312-995-9612