Healthcare Provider Details

I. General information

NPI: 1235796061
Provider Name (Legal Business Name): ABOVE THE LIGHT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4143 W 59TH ST
CHICAGO IL
60629-4946
US

IV. Provider business mailing address

4143 W 59TH ST
CHICAGO IL
60629-4946
US

V. Phone/Fax

Practice location:
  • Phone: 312-566-8294
  • Fax:
Mailing address:
  • Phone: 773-656-2102
  • 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 Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNY LEMUS
Title or Position: LICENSED COUNSELOR
Credential: LCPC
Phone: 773-656-2102