Provider Demographics
NPI:1386054682
Name:CITY HAVEN
Entity type:Organization
Organization Name:CITY HAVEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDING
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:847-830-4992
Mailing Address - Street 1:1735 N ASHLAND AVE
Mailing Address - Street 2:OFFICE 201
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-1435
Mailing Address - Country:US
Mailing Address - Phone:847-830-4992
Mailing Address - Fax:
Practice Address - Street 1:1735 N ASHLAND AVE
Practice Address - Street 2:OFFICE 201
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-1435
Practice Address - Country:US
Practice Address - Phone:847-830-4992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008183103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty