MEDICARE: CG THERAPIES LLC

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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1649783689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CG THERAPIES LLC

Provider Business Mailing Address
First Line	:	6427 N MAGNOLIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60626-5305
Country	:	US
Telephone Number	:	773-359-3505
Fax Number	:	312-489-8138

Provider Business Practice Location Address
First Line	:	1066 W GRANVILLE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60660-2156
Country	:	US
Telephone Number	:	773-359-3505
Fax Number	:	312-489-8138

Authorized Official
Title or Position	:	OWNER
Name	:	CHRISTI GARDNER
Credential	:	LCSW, CADC
Telephone Number	:	773-359-3505

Provider Enumeration Date	:	11/13/2017
Last Update Date	:	01/13/2025

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Directions to “CG THERAPIES LLC ” Practice Location

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