Provider Demographics
NPI:1174302731
Name:CANOPY COUNSELING CENTER PLLC
Entity type:Organization
Organization Name:CANOPY COUNSELING CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:YASMINE
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-557-1584
Mailing Address - Street 1:5844 W 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2718
Mailing Address - Country:US
Mailing Address - Phone:815-557-1584
Mailing Address - Fax:
Practice Address - Street 1:822 HILLGROVE AVE STE 2
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1474
Practice Address - Country:US
Practice Address - Phone:872-254-3804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)