MEDICARE: ARCH - C 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	261QM0855X	Adolescent and Children Mental Health Clinic/Center
2	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1720807415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARCH - C PLLC

Provider Business Mailing Address
First Line	:	1300 W BELMONT AVE STE 309
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3241
Country	:	US
Telephone Number	:	312-945-8651
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 W BELMONT AVE STE 309
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3241
Country	:	US
Telephone Number	:	312-945-8651
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PHILIPPUS BERNARDUS DE WET
Credential	:	LCPC
Telephone Number	:	773-308-4164

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	01/19/2026

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Directions to “ARCH - C PLLC ” Practice Location

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