Provider Demographics
NPI:1174131080
Name:CHICAGO TELEHEALTH, INC.
Entity type:Organization
Organization Name:CHICAGO TELEHEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-263-8855
Mailing Address - Street 1:3633 BREAKERS DR APT 329
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FLDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1063
Mailing Address - Country:US
Mailing Address - Phone:773-263-8855
Mailing Address - Fax:
Practice Address - Street 1:3633 BREAKERS DR APT 329
Practice Address - Street 2:
Practice Address - City:OLYMPIA FLDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1063
Practice Address - Country:US
Practice Address - Phone:773-263-8855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2020-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty