Provider Demographics
NPI:1104464254
Name:COUNSELING & ART THERAPY CENTER OF CHICAGO LLC
Entity type:Organization
Organization Name:COUNSELING & ART THERAPY CENTER OF CHICAGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER & COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, NCC, ATR-BC
Authorized Official - Phone:872-252-7836
Mailing Address - Street 1:155 N MICHIGAN AVE STE 325
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-7591
Mailing Address - Country:US
Mailing Address - Phone:872-252-7836
Mailing Address - Fax:
Practice Address - Street 1:155 N MICHIGAN AVE STE 325
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7591
Practice Address - Country:US
Practice Address - Phone:872-252-7836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-18
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty