Healthcare Provider Details

I. General information

NPI: 1649091703
Provider Name (Legal Business Name): HANNAH DAILEY MARRIAGE AND FAMILY THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/22/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 W ADAMS ST STE 1711 UNIT #1213
CHICAGO IL
60606-5147
US

IV. Provider business mailing address

318 W ADAMS ST STE 1711 UNIT #1213
CHICAGO IL
60606-5147
US

V. Phone/Fax

Practice location:
  • Phone: 312-741-4229
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HANNAH DAILEY WALSH
Title or Position: THERAPIST
Credential: LMFT
Phone: 312-741-4229