NPIMap

Organization Active NPI

Emdr Urban Healing Center LLC

  • Counselor
  • Chicago, IL
National Provider Identifier
1033719083
Registry record updated Dec 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
Legal business name
EMDR URBAN HEALING CENTER LLC
Practice address
3257 N Sheffield Ave Ste 110
Chicago, IL 60657-2276
Phone
(312) 248-1915
Fax
(773) 304-9878
NPI assigned
Oct 29, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Manrique, LCSW
Title
Owner
Phone
(312) 248-1915

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

3257 N Sheffield Ave Ste 110
Chicago, IL 60657-2276

Mailing address

3257 N Sheffield Ave Ste 110
Chicago, IL 60657-2276
Phone (312) 248-1915

Other names 1

  • Mezame Other name

National Provider Directory

National Provider Directory

Locations

5419 N Sheridan Rd
Ste 103A
Chicago, IL 60640
Phone (312) 248-1915

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702339200000",
    "number": "1033719083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3257 N SHEFFIELD AVE STE 110",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606572276",
            "telephone_number": "312-248-1915",
            "fax_number": "773-304-9878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3257 N SHEFFIELD AVE STE 110",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606572276",
            "telephone_number": "312-248-1915",
            "fax_number": "773-304-9878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EMDR URBAN HEALING CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-29",
        "last_updated": "2023-12-12",
        "certification_date": "2023-12-12",
        "status": "A",
        "authorized_official_last_name": "MANRIQUE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-248-1915",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mezame",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.