MEDICARE: CORAL HEART COUNSELING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	104100000X	Social Worker
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
4	261QM0850X	Adult Mental Health Clinic/Center
5	261QM0855X	Adolescent and Children Mental Health Clinic/Center
6	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1861088643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORAL HEART COUNSELING, LLC

Provider Business Mailing Address
First Line	:	320 W OHIO ST STE 3W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-7887
Country	:	US
Telephone Number	:	708-433-9363
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 W OHIO ST STE 3W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-7887
Country	:	US
Telephone Number	:	708-433-9363
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOTHERAPIST
Name	:	OLIVIA TAYLOR
Credential	:	LCSW
Telephone Number	:	773-790-3738

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	12/13/2024

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