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General NPI Number Information
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NPI Number | 1013633551
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Entity Type | Organization
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Legal Business Name | REDEFINE YOU THERAPY AND CONSULTATION
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Dates
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Enumeration Date | 10/17/2022
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Last Update Date | 10/17/2022
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Provider Practice Location Address
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Address Line | 5113 S HARPER AVE SUITE 2C
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City | CHICAGO
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State | IL
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Zip | 60615
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Country | US
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Telephone | 312-521-0866
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Fax |
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Provider Business Mailing Address
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Address Line | 5113 S HARPER AVE SUITE 2C
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City | CHICAGO
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State | IL
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Zip | 60615
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Country | US
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Telephone | 312-521-0866
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Fax |
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Authorized Official
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Title or Position | COUNSELOR/PRACTICE OWNER
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Name | KAREN CANNON
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Credential |
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Telephone | 312-521-0866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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