=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255280004
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CYPRESSHOLISTIC PSYCHIATRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2026
-----------------------------------------------------
Last Update Date | 01/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3440 N LAKE SHORE DR
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657-2818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-313-2710
-----------------------------------------------------
Fax | 312-386-5539
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1449 S MICHIGAN AVE STE 13354
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60605-2810
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-313-2710
-----------------------------------------------------
Fax | 312-386-5539
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/FOUNDER
-----------------------------------------------------
Name | CHIQUE HENDERSON
-----------------------------------------------------
Credential | APRN, PMHNP-BC
-----------------------------------------------------
Telephone | 312-523-4988
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------