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General NPI Number Information
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NPI Number | 1972095891
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Entity Type | Organization
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Legal Business Name | EXPLORE YOUR TRUTH INCOPORATED
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 1016 W JACKSON BLVD
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City | CHICAGO
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State | IL
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Zip | 60607-2914
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Country | US
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Telephone | 773-609-0307
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Fax |
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Provider Business Mailing Address
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Address Line | 10117 S MORGAN ST
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City | CHICAGO
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State | IL
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Zip | 60643-2222
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Country | US
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Telephone | 773-655-4544
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Fax |
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Authorized Official
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Title or Position | CEO / PRESIDENT
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Name | LISA N HOPKINS
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Credential | LCPC
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Telephone | 773-655-4544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 180005424
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 180005424
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License Number State | IL
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Taxonomy #3
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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 | 180005424
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License Number State | IL
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Taxonomy #4
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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 | 180-005424
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License Number State | IL
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