Healthcare Provider Details

I. General information

NPI: 1669229936
Provider Name (Legal Business Name): AUDERE PSYCHOTHERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2024
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

557 SKOKIE AVE
HIGHLAND PARK IL
60035-2031
US

IV. Provider business mailing address

557 SKOKIE AVE
HIGHLAND PARK IL
60035-2031
US

V. Phone/Fax

Practice location:
  • Phone: 312-569-9430
  • Fax:
Mailing address:
  • Phone:
  • 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: CHRISTOPHER MICHAEL CHIARELLA
Title or Position: OWNER
Credential: LCPC
Phone: 312-569-9430