| Chicago Youth Service Bureau | |
|
1525 E 53rd St Chicago IL 60615-4557 | |
| (773) 906-6690 | |
| Not Available |
| Full Name | Chicago Youth Service Bureau |
|---|---|
| Speciality | Counselor |
| Location | 1525 E 53rd St, Chicago, Illinois |
| Authorized Official Name and Position | Jessica Petty (LPC) |
| Authorized Official Contact | 7739066690 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Chicago Youth Service Bureau 1525 E 53rd St Chicago IL 60615-4557 Ph: () - | Chicago Youth Service Bureau 1525 E 53rd St Chicago IL 60615-4557 Ph: (773) 906-6690 |
| NPI Number | 1841995644 |
|---|---|
| Provider Enumeration Date | 04/03/2023 |
| Last Update Date | 06/19/2023 |
| Certification Date | 06/19/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841995644 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | (* (Not Available)) | Primary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Secondary |
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