Provider Demographics
NPI:1730861337
Name:LEAP THERAPY CHICAGO, PLLC
Entity type:Organization
Organization Name:LEAP THERAPY CHICAGO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:312-278-3771
Mailing Address - Street 1:1770 W BERTEAU AVE STE 304
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6131
Mailing Address - Country:US
Mailing Address - Phone:312-278-3771
Mailing Address - Fax:
Practice Address - Street 1:1770 W BERTEAU AVE STE 304
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-6131
Practice Address - Country:US
Practice Address - Phone:312-278-3771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty