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General NPI Number Information
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NPI Number | 1447716568
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Entity Type | Organization
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Legal Business Name | PATHOS CHICAGO LLC
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Dates
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Enumeration Date | 02/13/2019
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 430 W ERIE ST STE 205
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City | CHICAGO
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State | IL
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Zip | 60654-7692
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Country | US
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Telephone | 312-792-3610
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Fax |
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Provider Business Mailing Address
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Address Line | 430 W ERIE ST STE 205
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City | CHICAGO
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State | IL
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Zip | 60654-7692
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Country | US
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Telephone | 312-584-6635
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | ROBERT HILLIKER
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Credential |
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Telephone | 713-470-9878
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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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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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