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General NPI Number Information
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NPI Number | 1235973991
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Entity Type | Organization
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Legal Business Name | LINKED THERAPY IL
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Dates
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Enumeration Date | 06/19/2024
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Last Update Date | 08/29/2024
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Provider Practice Location Address
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Address Line | 365 N JEFFERSON ST
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City | CHICAGO
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State | IL
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Zip | 60661-1226
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Country | US
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Telephone | 317-207-6292
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Fax |
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Provider Business Mailing Address
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Address Line | 6929 E 10TH ST # 194
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4803
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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 | MANAGER
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Name | SHELIA HALL
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Credential |
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Telephone | 317-207-6292
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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 | 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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