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General NPI Number Information
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NPI Number | 1184165383
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Entity Type | Organization
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Legal Business Name | CHICAGO PSYCH THERAPY GROUP, INC.
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Dates
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Enumeration Date | 03/20/2017
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Last Update Date | 01/27/2026
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Provider Practice Location Address
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Address Line | 1603 ORRINGTON AVE
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City | EVANSTON
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State | IL
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Zip | 60201-3841
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Country | US
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Telephone | 312-781-2850
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Fax | 847-972-6445
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Provider Business Mailing Address
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Address Line | 8941 MARMORA AVE
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City | MORTON GROVE
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State | IL
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Zip | 60053-2448
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Country | US
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Telephone | 312-781-2850
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Fax | 847-972-6445
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Authorized Official
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Title or Position | OWNER
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Name | DR. TERRY DORNAK
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Credential | PSYD
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Telephone | 312-781-2850
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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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Taxonomy #2
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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 #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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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 | 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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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071009088
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License Number State | IL
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