Organization
BLACK TIE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MYRON NELSON LCPC (PRESIDENT)
(216) 832-1907
Entity
Organization
Contact information
Practice address
2232 N WAYNE AVE APT 1F, CHICAGO, IL 60614-8937
(773) 217-8426
Mailing address
2232 N WAYNE AVE APT 1F, CHICAGO, IL 60614-8937
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/21/2019
Last updated
09/04/2020
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