Healthcare Provider Details

I. General information

NPI: 1346100815
Provider Name (Legal Business Name): YOUPHORIA HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 W MORSE AVE
CHICAGO IL
60626-3112
US

IV. Provider business mailing address

1930 W MORSE AVE
CHICAGO IL
60626-3112
US

V. Phone/Fax

Practice location:
  • Phone: 917-721-3024
  • Fax: 773-388-0388
Mailing address:
  • Phone: 917-721-3024
  • Fax: 773-388-0388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AIDEN NICHOLSON
Title or Position: OWNER
Credential: APN, CNM
Phone: 917-721-3024