Healthcare Provider Details

I. General information

NPI: 1265100929
Provider Name (Legal Business Name): RAINY DAY ART THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W 35TH ST # 5B5230
CHICAGO IL
60609-1305
US

IV. Provider business mailing address

1200 W 35TH ST # 5B5230
CHICAGO IL
60609-1305
US

V. Phone/Fax

Practice location:
  • Phone: 773-340-3173
  • Fax:
Mailing address:
  • Phone: 773-340-3173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/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: REBECCA DEGRAW
Title or Position: ART THERAPIST
Credential: LCPC, ATR-BC
Phone: 773-340-3173