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General NPI Number Information
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NPI Number | 1104464254
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Entity Type | Organization
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Legal Business Name | COUNSELING & ART THERAPY CENTER OF CHICAGO LLC
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 07/05/2020
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Provider Practice Location Address
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Address Line | 155 N MICHIGAN AVE STE 325
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City | CHICAGO
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State | IL
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Zip | 60601-7591
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Country | US
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Telephone | 872-252-7836
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Fax |
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Provider Business Mailing Address
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Address Line | 155 N MICHIGAN AVE STE 325
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City | CHICAGO
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State | IL
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Zip | 60601-7591
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Country | US
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Telephone | 872-252-7836
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Fax |
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Authorized Official
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Title or Position | PRACTICE OWNER & COUNSELOR
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Name | JAMI PUGH
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Credential | LCPC, NCC, ATR-BC
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Telephone | 872-252-7836
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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 | 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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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 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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