Healthcare Provider Details

I. General information

NPI: 1427978915
Provider Name (Legal Business Name): TAPESTRY 360 HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

6200 N HIAWATHA AVE
CHICAGO IL
60646-4309
US

IV. Provider business mailing address

1301 W DEVON AVE
CHICAGO IL
60660-1329
US

V. Phone/Fax

Practice location:
  • Phone: 773-296-7589
  • 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: MRS. NICOLE WILLIS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MBA
Phone: 773-296-7589