Provider Demographics
NPI:1336733153
Name:ANCHORED IN WELLNESS CHICAGO LLC
Entity type:Organization
Organization Name:ANCHORED IN WELLNESS CHICAGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:JR
Authorized Official - Credentials:LCSW, CADC
Authorized Official - Phone:773-430-9253
Mailing Address - Street 1:1440 W TAYLOR ST # 767
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4623
Mailing Address - Country:US
Mailing Address - Phone:773-430-9253
Mailing Address - Fax:
Practice Address - Street 1:4807 S ASHLAND AVE APT 203
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60609-4242
Practice Address - Country:US
Practice Address - Phone:773-430-9253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)