Healthcare Provider Details

I. General information

NPI: 1851993877
Provider Name (Legal Business Name): HAINLINE THERAPEUTIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 12/05/2020
Certification Date: 12/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 E 55TH ST # 301B
CHICAGO IL
60615-5512
US

IV. Provider business mailing address

2229 N KIMBALL AVE APT 3E
CHICAGO IL
60647-3545
US

V. Phone/Fax

Practice location:
  • Phone: 312-572-9866
  • Fax:
Mailing address:
  • Phone: 312-320-5665
  • 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 Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health 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: ARIEL HAINLINE
Title or Position: SOLE MEMBER
Credential: LCSW
Phone: 312-320-5665