Provider Demographics
NPI:1841067865
Name:LUCENT PSYCHOTHERAPY
Entity type:Organization
Organization Name:LUCENT PSYCHOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KANCHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRICH
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-270-2329
Mailing Address - Street 1:4822 W BERTEAU AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-1600
Mailing Address - Country:US
Mailing Address - Phone:847-767-1997
Mailing Address - Fax:
Practice Address - Street 1:4822 W BERTEAU AVE APT 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1600
Practice Address - Country:US
Practice Address - Phone:847-767-1997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health