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General NPI Number Information
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NPI Number | 1659696185
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Entity Type | Organization
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Legal Business Name | CBT CLINIC OF CHICAGO, P.C.
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Dates
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Enumeration Date | 03/26/2010
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Last Update Date | 03/26/2010
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Provider Practice Location Address
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Address Line | 180 N STETSON AVE SUITE 3150
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City | CHICAGO
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State | IL
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Zip | 60601-6710
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Country | US
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Telephone | 312-228-4200
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Fax | 312-540-1231
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Provider Business Mailing Address
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Address Line | 180 N STETSON AVE SUITE 3150
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City | CHICAGO
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State | IL
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Zip | 60601-6710
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Country | US
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Telephone | 312-228-4200
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Fax | 312-540-1231
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELISE D MASSIE
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Credential | PH.D.
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Telephone | 312-228-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071007344
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 071007344
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License Number State | IL
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