MEDICARE: LYDIA HOME ASSOCIATION

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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	322D00000X	Emotionally Disturbed Childrens' Residential Treatment Facility	062837	IL

General Provider Information

NPI Number	:	1235197583
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYDIA HOME ASSOCIATION

Provider Business Mailing Address
First Line	:	4300 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2825
Country	:	US
Telephone Number	:	773-736-1447
Fax Number	:	773-736-5014

Provider Business Practice Location Address
First Line	:	4300 W IRVING PARK RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2825
Country	:	US
Telephone Number	:	773-736-1447
Fax Number	:	773-736-5014

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. DAVID KARL ANDERSON
Credential	:	PSYD
Telephone Number	:	773-736-1447

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	06/24/2022

Similar Medicare Providers

1316904956 — LYDIA HOME ASSOCIATION
Practice Location Address:

4300 W IRVING PARK RD #B , COUNSELING CENTER
CHICAGO, IL
60641-2825

Practice Phone: 773-736-1447
Practice Fax: 773-736-6970

1346208410 — ALLAN T. PETERSON PSY. D, MDIV
Practice Location Address:

4300 W IRVING PARK RD , COUNSELING CENTER
CHICAGO, IL
60641-2825

Practice Phone: 773-736-1447
Practice Fax: 773-736-6970

1225234297 — MR. ALBERT WOLFE LASER LCPC
Practice Location Address:

LYDIA HOME ASSOCIATION , 4300 W IRVING PARK RD
CHICAGO, IL
60641-2825

Practice Phone: 773-736-1447
Practice Fax: 773-736-6970

1689871345 — DR. DAVID KARL ANDERSON PSY.D.
Practice Location Address:

4300 W IRVING PARK RD
CHICAGO, IL
60641-2825

Practice Phone: 773-736-1447
Practice Fax: 773-736-6970

1285832998 — MRS. PATRICIA JANE UTIGARD MSW
Practice Location Address:

4300 W IRVING PARK RD
CHICAGO, IL
60641-2825

Practice Phone: 773-736-1447
Practice Fax: 773-736-5014

1477752384 — LYNWOOD WAYNE MORRISS
Practice Location Address:

4300 W IRVING PARK RD
CHICAGO, IL
60641-2825

Practice Phone: 773-336-1447
Practice Fax: 773-736-5014

Directions to “LYDIA HOME ASSOCIATION ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.