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General NPI Number Information
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NPI Number | 1427767623
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Entity Type | Organization
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Legal Business Name | YOUR IDENTITY COUNSELING, PLLC
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Dates
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Enumeration Date | 11/16/2022
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 119 S WESTERN AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60612-4644
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Country | US
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Telephone | 773-234-4038
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Fax | 773-389-3599
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Provider Business Mailing Address
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Address Line | 119 S WESTERN AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60612-4644
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Country | US
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Telephone | 773-234-4038
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Fax | 773-389-3599
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Authorized Official
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Title or Position | OWNER
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Name | AVERY M RAVITZ
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Credential | LCPC
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Telephone | 773-873-2969
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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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