Provider Demographics
NPI:1720807415
Name:ARCH - C PLLC
Entity type:Organization
Organization Name:ARCH - C PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIPPUS
Authorized Official - Middle Name:BERNARDUS
Authorized Official - Last Name:DE WET
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-308-4164
Mailing Address - Street 1:1300 W BELMONT AVE STE 400F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3200
Mailing Address - Country:US
Mailing Address - Phone:312-945-8651
Mailing Address - Fax:
Practice Address - Street 1:1300 W BELMONT AVE STE 400F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3200
Practice Address - Country:US
Practice Address - Phone:312-945-8651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health