Provider Demographics
NPI:1588415236
Name:CLT & ASSOCIATES THERAPY AND MEDIATION SERVICES, PLLC
Entity type:Organization
Organization Name:CLT & ASSOCIATES THERAPY AND MEDIATION SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHEVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:TONEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-616-6604
Mailing Address - Street 1:6625 CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-9998
Mailing Address - Country:US
Mailing Address - Phone:773-616-6604
Mailing Address - Fax:
Practice Address - Street 1:1930 LOMBARD AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-2047
Practice Address - Country:US
Practice Address - Phone:773-616-6604
Practice Address - Fax:708-775-6342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty