Organization
CHICAGO YOUTH SERVICE BUREAU
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA PETTY (LPC)
(773) 906-6690
Entity
Organization
Contact information
Practice address
1525 E 53RD ST, CHICAGO, IL 60615-4557
(773) 906-6690
Mailing address
1525 E 53RD ST, CHICAGO, IL 60615-4557
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Enumeration date
04/03/2023
Last updated
06/19/2023
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