MEDICARE: AHA MOMENT THERAPY, PLLC

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	1041C0700X	Clinical Social Worker
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1538014782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AHA MOMENT THERAPY, PLLC

Provider Business Mailing Address
First Line	:	1650 N MONTICELLO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4719
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1650 N MONTICELLO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4719
Country	:	US
Telephone Number	:	872-216-1634
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	ELENA KNEELAND
Credential	:	LCPC
Telephone Number	:	773-814-7396

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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