Organization Active NPI

Drive Psychotherapy PLLC

  • Mental Health Counselor
  • Chicago, IL
National Provider Identifier
1619767811
Registry record updated Jun 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
DRIVE PSYCHOTHERAPY PLLC
Practice address
4619 N Ravenswood Ave # 104-D
Chicago, IL 60640-4580
Phone
(847) 933-0051
NPI assigned
May 9, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 4, 2025

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

Authorized official

Name
Robert Foreman
Title
Credentialing
Phone
(630) 313-0069

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary

Addresses

Primary practice location

4619 N Ravenswood Ave # 104-D
Chicago, IL 60640-4580

Mailing address

4619 N Ravenswood Ave Ste 104-D
Chicago, IL 60640-4580
Phone (901) 482-8052

National Provider Directory

National Provider Directory

Locations

4619 N Ravenswood Ave
Ste 104D
Chicago, IL 60640
Phone (312) 285-0535

4619 N Ravenswood Ave
#104D
Chicago, IL 60640
Phone (847) 933-0051

Practitioners & affiliated clinicians

Practitioners 1

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": "1746748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748995200000",
    "number": "1619767811",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4619 N RAVENSWOOD AVE STE 104-D",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404580",
            "telephone_number": "901-482-8052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4619 N RAVENSWOOD AVE # 104-D",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404580",
            "telephone_number": "847-933-0051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DRIVE PSYCHOTHERAPY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-09",
        "last_updated": "2025-06-04",
        "certification_date": "2025-06-04",
        "status": "A",
        "authorized_official_last_name": "FOREMAN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CREDENTIALING",
        "authorized_official_telephone_number": "630-313-0069"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Jun 4, 2025; 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.