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General NPI Number Information
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NPI Number | 1114406873
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Entity Type | Organization
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Legal Business Name | CHICAGO PRIDE CENTER
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 4809 N RAVENSWOOD AVE UNIT 210
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City | CHICAGO
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State | IL
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Zip | 60640-4417
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Country | US
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Telephone | 773-334-3533
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Fax |
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Provider Business Mailing Address
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Address Line | 7637 N BOSWORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60626-7159
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Country | US
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Telephone | 773-319-4325
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Fax | 773-439-5683
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Authorized Official
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Title or Position | CFO
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Name | MR. HUGH COLE
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Credential | LCSW
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Telephone | 773-334-3533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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