Provider Demographics
NPI:1487260188
Name:EXPOSURE THERAPY CHICAGO PLLC
Entity type:Organization
Organization Name:EXPOSURE THERAPY CHICAGO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:307-399-1228
Mailing Address - Street 1:661 W LAKE ST STE 2S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1034
Mailing Address - Country:US
Mailing Address - Phone:312-471-3910
Mailing Address - Fax:844-654-9548
Practice Address - Street 1:661 W LAKE ST STE 2S
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-1034
Practice Address - Country:US
Practice Address - Phone:312-471-3910
Practice Address - Fax:844-654-9548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-17
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)