NPIMap

Organization Active NPI

Chicago Psych Therapy Group, Inc.

Doing business as Gulf Coast Psych Therapy Group

  • Clinical Psychologist
  • Evanston, IL
National Provider Identifier
1184165383
Registry record updated Jan 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
071009088 Issued in IL
Legal business name
CHICAGO PSYCH THERAPY GROUP, INC.
Doing business as
Gulf Coast Psych Therapy Group
Practice address
1603 Orrington Ave
Evanston, IL 60201-3841
Phone
(312) 781-2850
Fax
(847) 972-6445
NPI assigned
Mar 20, 2017
Last updated
Jan 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2026

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

Authorized official

Name
Dr. Terry Dornak, PSYD
Title
Owner
Phone
(312) 781-2850

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Clinical Psychologist 103TC0700X
Clinical Psychologist 103TC0700X 071009088 IL Primary
Clinical Social Worker 1041C0700X
Massage Therapist 225700000X

Addresses

Primary practice location

1603 Orrington Ave
Evanston, IL 60201-3841

Mailing address

8941 Marmora Ave
Morton Grove, IL 60053-2448
Phone (312) 781-2850

Other practice location 1

6300 Corporate Ct Ste 103
Fort Myers, FL 33919-3513
Phone (312) 781-2850

Other names 1

  • Gulf Coast Psych Therapy Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180510000420 IL Part B Supplier - Clinic/Group Practice 9537423959 Receives reassigned benefits from 2 practitioners
Practice locations: Evanston, IL

National Provider Directory

National Provider Directory

Locations

3525 W Peterson Ave
Ste 522
Chicago, IL 60659
Phone (312) 781-2850

828 Davis St
Ste 213
Evanston, IL 60201
Phone (312) 781-2850

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1489968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1769472000000",
    "number": "1184165383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8941 MARMORA AVE",
            "city": "MORTON GROVE",
            "state": "IL",
            "postal_code": "600532448",
            "telephone_number": "312-781-2850",
            "fax_number": "847-972-6445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1603 ORRINGTON AVE",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602013841",
            "telephone_number": "312-781-2850",
            "fax_number": "847-972-6445"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6300 Corporate Ct Ste 103",
            "address_purpose": "LOCATION",
            "city": "Fort Myers",
            "state": "FL",
            "postal_code": "339193513",
            "country_code": "US",
            "telephone_number": "312-781-2850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CHICAGO PSYCH THERAPY GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-20",
        "last_updated": "2026-01-27",
        "certification_date": "2026-01-27",
        "status": "A",
        "authorized_official_last_name": "DORNAK",
        "authorized_official_first_name": "TERRY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "312-781-2850",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071009088",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gulf Coast Psych Therapy Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gulf Coast Psych Therapy Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.