MEDICARE: CEREBRO PSYCHOTHERAPY AND WELLNESS SERVICES, 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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1720913510
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CEREBRO PSYCHOTHERAPY AND WELLNESS SERVICES, PLLC

Provider Business Mailing Address
First Line	:	980 N MICHIGAN AVE STE 1085
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-4525
Country	:	US
Telephone Number	:	888-692-6778
Fax Number	:

Provider Business Practice Location Address
First Line	:	4753 N BROADWAY ST FL 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5266
Country	:	US
Telephone Number	:	773-977-8195
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/PSYCHOTHERAPIST
Name	:	YVETTE KYRIAK LOPEZ
Credential	:	LCSW
Telephone Number	:	773-977-8195

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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