Healthcare Provider Details

I. General information

NPI: 1720913510
Provider Name (Legal Business Name): CEREBRO PSYCHOTHERAPY AND WELLNESS SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4753 N BROADWAY ST FL 2
CHICAGO IL
60640-5266
US

IV. Provider business mailing address

980 N MICHIGAN AVE STE 1085
CHICAGO IL
60611-4525
US

V. Phone/Fax

Practice location:
  • Phone: 773-977-8195
  • Fax:
Mailing address:
  • Phone: 888-692-6778
  • 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

VIII. Authorized Official

Name: YVETTE KYRIAK LOPEZ
Title or Position: FOUNDER/PSYCHOTHERAPIST
Credential: LCSW
Phone: 773-977-8195