Modern Soul Therapy LLC
Counselor (Mental Health)

Address: 2000 N Racine Ave Ste 2160, Chicago, IL 60614-4045
Phone: 7404086407

Modern Soul Therapy LLC (NPI# 1013516145) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider Identifier (NPI) 1013516145
Entity Type Organization
Organization Name MODERN SOUL THERAPY LLC
Practice Address 2000 N Racine Ave Ste 2160
Chicago
IL 60614-4045
Practice Telephone 7404086407
Mailing Address 375 Market St Unit 304
Brighton
MA 02135-2754
Mailing Telephone 7404086407
Authorized Official Name Mallory A Ingram (THERAPIST)
Authorized Official Telephone 7404086407
Authorized Official Credential LCPC
Organization Subpart No, this organization is not a Subpart
Enumeration Date 2020-10-20
Last Update Date 2020-10-20

Taxonomy Codes

Primary Taxonomy Classification Taxonomy Group License Number State
Yes 101YM0800X Counselor · Mental Health Behavioral Health & Social Service Providers

Other Provider Identifier

State Identifier Issuer Type Code
09322531 OTHER PRIVATE INSURANCE

Taxonomy Information

Taxonomy Code 101YM0800X
Grouping Behavioral Health & Social Service Providers
Classification Counselor
Specialization Mental Health

Taxonomy Definition

Definition to come...

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Office Location

Street Address 2000 N RACINE AVE STE 2160
City CHICAGO
State IL
Zip Code 60614-4045

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1487266516 Taylor Connington Pharmacist 843 W Armitage Ave, Chicago, IL 60614 2020-08-19
1356975692 Amarilis Diaz Social Worker Terry Hefter Associates, LLC, 1731 N. Marcey Suite 535, Chicago, IL 60614 2020-02-25
1457902975 Michele Waggoner Physical Therapist 2515 N. Clark St, Chicago, IL 60614 2019-09-25
1669031936 Justin Pomeroy Acupuncturist 1350 W. Schubert Ave., Chicago, IL 60614 2019-06-11
1801451547 Amanda Harris Counselor 2451 N Lincoln Ave # 206, Chicago, IL 60614 2019-05-08
1780164574 Danielle Trokey Psychiatry & Neurology 2515 N Clark St Ste 801, Chicago, IL 60614 2018-08-21
1841707353 Madison Counseling Solutions LLC Social Worker 2502 N. Clark St., Chicago, IL 60614 2018-01-05
1386154011 Allison Cooper Boyan Occupational Therapist 1640 N. Wells St., Unit 103, Chicago, IL 60614 2017-10-09
1245759653 Eileen Davidson Siegel Physician Assistant 2073 N. Clybourn Ave., Chicago, IL 60614 2017-09-18
1447779814 Elizabeth Hobart Psychologist 1800 W. Diversey Pkwy, Unit H, Chicago, IL 60614 2017-09-16
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Competitor

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City CHICAGO
Zip Code 60614

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.