MEDICARE: CHICAGO INTEGRATED PSYCHOTHERAPY INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1083310106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO INTEGRATED PSYCHOTHERAPY INCORPORATED

Provider Business Mailing Address
First Line	:	1117 W ALBION AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4613
Country	:	US
Telephone Number	:	773-562-6244
Fax Number	:	773-562-6244

Provider Business Practice Location Address
First Line	:	1117 W ALBION AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-4613
Country	:	US
Telephone Number	:	773-562-6244
Fax Number	:	773-562-6244

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. ANUJ ANSAL
Credential	:	MA, LPC, CRC
Telephone Number	:	773-562-6244

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	03/03/2026

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