=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134062821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHICAGO COUNSELING CENTER, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2026
-----------------------------------------------------
Last Update Date | 04/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6160 N CICERO AVE STE 630
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60646-4325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-932-9597
-----------------------------------------------------
Fax | 773-243-0519
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6140 N KILBOURN AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60646-5020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-932-9597
-----------------------------------------------------
Fax | 773-453-0519
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MR. TAYLOR K NEWENDORP
-----------------------------------------------------
Credential | MA, LCPC
-----------------------------------------------------
Telephone | 773-932-9597
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------