Healthcare Provider Details

I. General information

NPI: 1841049582
Provider Name (Legal Business Name): ECHO THERAPY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2024
Last Update Date: 05/15/2024
Certification Date: 05/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5419 W LAWRENCE AVE
CHICAGO IL
60630-3686
US

IV. Provider business mailing address

5419 W LAWRENCE AVE
CHICAGO IL
60630-3686
US

V. Phone/Fax

Practice location:
  • Phone: 773-510-4072
  • Fax:
Mailing address:
  • Phone: 773-510-4072
  • 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 Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: BARBARA MURPHY
Title or Position: OWNER
Credential: LCSW
Phone: 773-510-4072