Provider Demographics
NPI:1972095891
Name:EXPLORE YOUR TRUTH INCOPORATED
Entity type:Organization
Organization Name:EXPLORE YOUR TRUTH INCOPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:N
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-655-4544
Mailing Address - Street 1:10117 S MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-2222
Mailing Address - Country:US
Mailing Address - Phone:773-655-4544
Mailing Address - Fax:
Practice Address - Street 1:1016 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-2914
Practice Address - Country:US
Practice Address - Phone:773-609-0307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EXPLORING YOUR TRUTH INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005424251S00000X, 261QM0850X, 261QM0855X
IL180-005424261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health