Healthcare Provider Details

I. General information

NPI: 1811657513
Provider Name (Legal Business Name): ARIADNE COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2544 W CORTEZ ST APT 2F
CHICAGO IL
60622-3444
US

IV. Provider business mailing address

2544 W CORTEZ ST APT 2F
CHICAGO IL
60622-3444
US

V. Phone/Fax

Practice location:
  • Phone: 541-905-0894
  • Fax:
Mailing address:
  • Phone: 541-905-0894
  • 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: POYESH GANJI
Title or Position: COUNSELOR
Credential: LMFT
Phone: 541-905-0893