| Humboldt Park Counseling, Pllc | |
|
938 N California Ave Commercial Unit Chicago IL 60622-1435 | |
| (312) 620-0408 | |
| Not Available |
| Full Name | Humboldt Park Counseling, Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 938 N California Ave, Chicago, Illinois |
| Authorized Official Name and Position | Carolyn Sellers (OWNER, PSYCHOTHERAPIST) |
| Authorized Official Contact | 3126200408 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Humboldt Park Counseling, Pllc 3446 W Hirsch St Chicago IL 60651-2314 Ph: (312) 620-0408 | Humboldt Park Counseling, Pllc 938 N California Ave Commercial Unit Chicago IL 60622-1435 Ph: (312) 620-0408 |
| NPI Number | 1750995650 |
|---|---|
| Provider Enumeration Date | 09/08/2020 |
| Last Update Date | 10/15/2021 |
| Certification Date | 09/30/2021 |
| Medicare PECOS PAC ID | 9537542485 |
|---|---|
| Medicare Enrollment ID | O20220810002478 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750995650 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| Provider Name | Carolyn M Sellers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871025940 PECOS PAC ID: 1658612718 Enrollment ID: I20190418000742 |
| Provider Name | Rickele Jasmine Coy |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669074944 PECOS PAC ID: 8426434267 Enrollment ID: I20221003001682 |
| Provider Name | Alexis Lauren Keilly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1881348035 PECOS PAC ID: 9335525070 Enrollment ID: I20221003002093 |
| Provider Name | Silvia Nora Rosman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285114959 PECOS PAC ID: 2668827791 Enrollment ID: I20231010002804 |
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