Healthcare Provider Details

I. General information

NPI: 1720807415
Provider Name (Legal Business Name): ARCH - C PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W BELMONT AVE STE 309
CHICAGO IL
60657-3241
US

IV. Provider business mailing address

1300 W BELMONT AVE STE 309
CHICAGO IL
60657-3241
US

V. Phone/Fax

Practice location:
  • Phone: 312-945-8651
  • Fax:
Mailing address:
  • Phone: 312-945-8651
  • 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: MR. PHILIPPUS BERNARDUS DE WET
Title or Position: OWNER
Credential: LCPC
Phone: 773-308-4164