MEDICARE: INNER HAVEN THERAPY AND WELLNESS 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	:	1730030388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INNER HAVEN THERAPY AND WELLNESS PLLC

Provider Business Mailing Address
First Line	:	4813 N PAULINA ST APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-0113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4813 N PAULINA ST APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-0113
Country	:	US
Telephone Number	:	414-403-6993
Fax Number	:

Authorized Official
Title or Position	:	OWNER, PSYCHOTHERAPIST
Name	:	LUKE THIMMESCH
Credential	:
Telephone Number	:	414-403-6993

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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