Healthcare Provider Details

I. General information

NPI: 1144124744
Provider Name (Legal Business Name): FUTURE ANCESTORS CLUB, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 N RAVENSWOOD AVE
CHICAGO IL
60613-5651
US

IV. Provider business mailing address

3838 N RAVENSWOOD AVE
CHICAGO IL
60613-5651
US

V. Phone/Fax

Practice location:
  • Phone: 773-656-1749
  • Fax:
Mailing address:
  • Phone: 773-656-1749
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: GRACE OCZON
Title or Position: FOUNDER
Credential: LCPC
Phone: 773-656-1749