Bucktown Therapy
Community/Behavioral Health in Chicago, IL. Organization (NPI-2).
NPI number1962032086
StatusActive
Last updated in NPPESJan 16, 2020
Details
- NPI
- 1962032086
- Entity type
- Organization (NPI-2)
- Legal business name
- Bucktown Therapy
- Organization subpart
- No
- Enumeration date
- Jan 16, 2020
- Certification date
- Jan 16, 2020
- Last updated
- Jan 16, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 251S00000X | Community/Behavioral Health | – | – | Yes |
Practice location
1820 W Webster Ave Ste 200Chicago, IL 60614-2934
Phone 630-733-8595
Mailing address
3125 W Fullerton Ave Apt 212Chicago, IL 60647-6959
Phone 920-418-1165
Authorized official
Kristin Ridder
Clinical Psychologist
9204181165
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