Healthcare Provider Details

I. General information

NPI: 1790593473
Provider Name (Legal Business Name): ERIC LINDQUIST-LICENSED CLINICAL COUNSELOR, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2024
Last Update Date: 12/26/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10725 S WESTERN AVE
CHICAGO IL
60643-3217
US

IV. Provider business mailing address

10725 S WESTERN AVE
CHICAGO IL
60643-3217
US

V. Phone/Fax

Practice location:
  • Phone: 773-875-8803
  • Fax:
Mailing address:
  • Phone: 773-875-8803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC DANIEL LINDQUIST
Title or Position: OWNER/THERAPIST
Credential: LCPC
Phone: 773-875-8803