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General NPI Number Information
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NPI Number | 1851993877
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Entity Type | Organization
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Legal Business Name | HAINLINE THERAPEUTIC SERVICES PLLC
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Dates
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Enumeration Date | 11/13/2020
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Last Update Date | 12/05/2020
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Provider Practice Location Address
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Address Line | 1525 E 55TH ST # 301B
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City | CHICAGO
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State | IL
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Zip | 60615-5512
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Country | US
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Telephone | 312-572-9866
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Fax |
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Provider Business Mailing Address
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Address Line | 2229 N KIMBALL AVE APT 3E
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City | CHICAGO
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State | IL
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Zip | 60647-3545
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Country | US
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Telephone | 312-320-5665
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | ARIEL HAINLINE
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Credential | LCSW
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Telephone | 312-320-5665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health 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 | 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 #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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