Healthcare Provider Details

I. General information

NPI: 1811828569
Provider Name (Legal Business Name): FOUNTAIN PSYCHOTHERAPY & CONSULTATION, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 N NORMANDY AVE
CHICAGO IL
60656-2119
US

IV. Provider business mailing address

5425 N NORMANDY AVE
CHICAGO IL
60656-2119
US

V. Phone/Fax

Practice location:
  • Phone: 773-309-1709
  • Fax:
Mailing address:
  • Phone: 773-309-1709
  • 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: LAUREN SCHMIDT
Title or Position: FOUNDER
Credential: LCSW
Phone: 630-439-5358