Healthcare Provider Details

I. General information

NPI: 1043994478
Provider Name (Legal Business Name): CONNECTION CLINICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 N HALSTED ST STE 203
CHICAGO IL
60614-4365
US

IV. Provider business mailing address

2001 N HALSTED ST STE 203
CHICAGO IL
60614-4365
US

V. Phone/Fax

Practice location:
  • Phone: 872-267-2427
  • Fax:
Mailing address:
  • Phone: 872-267-2427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARGARET HENSLEY KHOSHABA
Title or Position: CO-OWNER
Credential: LMFT
Phone: 872-267-2427