MEDICARE: CHICAGO THERAPY CENTERS

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1134667868
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO THERAPY CENTERS

Provider Business Mailing Address
First Line	:	2451 N LINCOLN AVE
Second Line	:	SUITE 204
City	:	CHICAGO
State	:	IL
Zip	:	60614-1509
Country	:	US
Telephone Number	:	708-724-5668
Fax Number	:	773-661-2640

Provider Business Practice Location Address
First Line	:	2451 N LINCOLN AVE
Second Line	:	SUITE 204
City	:	CHICAGO
State	:	IL
Zip	:	60614-1509
Country	:	US
Telephone Number	:	708-724-5668
Fax Number	:	773-661-2640

Authorized Official
Title or Position	:	OWNER
Name	:	MATTHEW GALLO
Credential	:	LPC
Telephone Number	:	708-724-5668

Provider Enumeration Date	:	02/01/2017
Last Update Date	:	02/01/2017

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