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General NPI Number Information
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NPI Number | 1316747538
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Entity Type | Organization
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Legal Business Name | NORTHSIDE CENTER FOR RELATIONSHIP COUNSELING
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Dates
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Enumeration Date | 03/17/2025
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 5100 N RAVENSWOOD AVE STE 208
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City | CHICAGO
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State | IL
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Zip | 60640-1710
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Country | US
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Telephone | 773-791-0469
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Fax |
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Provider Business Mailing Address
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Address Line | 5100 N RAVENSWOOD AVE STE 208
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City | CHICAGO
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State | IL
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Zip | 60640-1710
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Country | US
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Telephone | 773-791-0469
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOSHUA SMITH HETHERINGTON
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Credential | LMFT, LCPC
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Telephone | 773-791-0469
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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