Healthcare Provider Details

I. General information

NPI: 1770172298
Provider Name (Legal Business Name): REFLECTIVE THERAPY & CONSULTING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 04/27/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 N SEDGWICK ST # 1F
CHICAGO IL
60614-5722
US

IV. Provider business mailing address

1710 N SEDGWICK ST # 1F
CHICAGO IL
60614-5722
US

V. Phone/Fax

Practice location:
  • Phone: 773-316-8032
  • Fax:
Mailing address:
  • Phone: 773-316-8032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: AMALIA C PRYOR
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 773-316-8032