Chicago Nerd Therapy, PLLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

CHICAGO NERD THERAPY, PLLC

Doing business as

Keystone Mental Health

Practice address

5230 N Mobile Ave
Chicago, IL 60630-1010

Phone

(312) 270-0098

NPI assigned

Apr 20, 2021

Organization subpart

No

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

Authorized official

Name

Eric Koll, LCSWNPI 1285025890

Title

Clinical Social Worker

Phone

(312) 270-0098

Specialties & licenses 1

Addresses

Other names 2

• Keystone Mental Health Doing business as
• Chicago Nerd Therapy, PLLC Other name

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eric Daniel Koll, LMSW

  • Social Worker
  • Rochester, NY
  • NPI 1285025890
  NPD Authorized official

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

{
    "created_epoch": "1618876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695168000000",
    "number": "1164003190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4306 N LINCOLN AVE UNIT 2F",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606181712",
            "telephone_number": "312-270-0098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5230 N MOBILE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606301010",
            "telephone_number": "312-270-0098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO NERD THERAPY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-20",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A",
        "authorized_official_last_name": "KOLL",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "CLINICAL SOCIAL WORKER",
        "authorized_official_telephone_number": "312-270-0098",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keystone Mental Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Chicago Nerd Therapy, PLLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Chicago Neck & Back Institute LTD. PC
• Chicago Neighborhood Therapy Inc.
• Chicago Nephrology Associates, LLC
• Chicago Neurobehavioral Associates LLC
• Chicago Neurology Group SC
• Chicago Neuropsychological Services
• Chicago Neuropsychological Services
• Chicago Neurorehabilitation Center LLC

• Adult Mental Health Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Adult Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.