MEDICARE: CITY HAVEN COUNELING

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	103T00000X	Psychologist	071008183	IL

General Provider Information

NPI Number	:	1194270108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY HAVEN COUNELING

Provider Business Mailing Address
First Line	:	1735 N ASHLAND AVE
Second Line	:	SUITE 201
City	:	CHICAGO
State	:	IL
Zip	:	60622-1435
Country	:	US
Telephone Number	:	312-489-7490
Fax Number	:	773-303-8837

Provider Business Practice Location Address
First Line	:	1735 N ASHLAND AVE
Second Line	:	SUITE 201
City	:	CHICAGO
State	:	IL
Zip	:	60622-1435
Country	:	US
Telephone Number	:	312-489-7490
Fax Number	:	773-303-8837

Authorized Official
Title or Position	:	OWNER/PRACTIONER
Name	:	DR. KATHERINE MCNAIR HARDING
Credential	:	PSYD
Telephone Number	:	312-489-7490

Provider Enumeration Date	:	08/19/2016
Last Update Date	:	08/19/2016

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Directions to “CITY HAVEN COUNELING ” Practice Location

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