Healthcare Provider Details

I. General information

NPI: 1265360358
Provider Name (Legal Business Name): XICAGO THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 W 35TH ST
CHICAGO IL
60609-1309
US

IV. Provider business mailing address

1653 W 35TH ST
CHICAGO IL
60609-1309
US

V. Phone/Fax

Practice location:
  • Phone: 773-980-6784
  • Fax:
Mailing address:
  • Phone: 773-980-6784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ANA CARMEN CHAVEZ
Title or Position: OWNER/MANAGER
Credential: LCSW
Phone: 773-963-4776