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General NPI Number Information
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NPI Number | 1720407679
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Entity Type | Organization
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Legal Business Name | HEAD HEART THERAPY INC
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Dates
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Enumeration Date | 04/08/2014
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Last Update Date | 11/11/2025
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Provider Practice Location Address
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Address Line | 4411 N RAVENSWOOD AVE # 250
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City | CHICAGO
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State | IL
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Zip | 60640-5802
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Country | US
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Telephone | 816-729-1719
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Fax | 773-869-5385
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Provider Business Mailing Address
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Address Line | 4411 N RAVENSWOOD AVE # 250
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City | CHICAGO
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State | IL
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Zip | 60640-5802
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Country | US
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Telephone | 816-729-1719
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Fax | 773-869-5385
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Authorized Official
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Title or Position | OWNER
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Name | MS. RAYELL GRAYSON
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Credential | LCPC, CADC
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Telephone | 816-729-1719
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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