Healthcare Provider Details

I. General information

NPI: 1376373365
Provider Name (Legal Business Name): BLH THERAPY GROUP, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 N COLUMBUS DR UNIT 5409
CHICAGO IL
60601-5269
US

IV. Provider business mailing address

225 N COLUMBUS DR UNIT 5409
CHICAGO IL
60601-5269
US

V. Phone/Fax

Practice location:
  • Phone: 312-248-3406
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK ELLIOTT
Title or Position: PRESIDENT
Credential: MD
Phone: 312-248-3406