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General NPI Number Information
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NPI Number | 1285498428
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Entity Type | Organization
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Legal Business Name | MYTHOS PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 02/08/2024
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 155 N MICHIGAN AVE STE 723
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City | CHICAGO
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State | IL
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Zip | 60601-7707
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Country | US
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Telephone | 312-248-3390
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Fax |
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Provider Business Mailing Address
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Address Line | 680 N LAKE SHORE DR APT 816
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City | CHICAGO
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State | IL
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Zip | 60611-4461
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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 | FOUNDER/PSYCHOTHERAPIST
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Name | JORDAN PRAGER WHITE
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Credential |
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Telephone | 312-248-3390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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