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General NPI Number Information
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NPI Number | 1033949490
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Entity Type | Organization
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Legal Business Name | YOUR AUTISTIC THERAPIST PC
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Dates
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Enumeration Date | 08/01/2024
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 5655 N WAYNE AVE APT 1S
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City | CHICAGO
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State | IL
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Zip | 60660-5543
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Country | US
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Telephone | 773-242-9427
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Fax |
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Provider Business Mailing Address
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Address Line | 1055 W BRYN MAWR AVE STE F
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City | CHICAGO
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State | IL
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Zip | 60660-4692
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SUE COOK
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Credential | LCSW
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Telephone | 773-242-9427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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