My Art Therapy Studio, PLLC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

Legal business name

MY ART THERAPY STUDIO, PLLC

Practice address

3124 W Logan Blvd
Chicago, IL 60647-1627

Phone

(312) 278-7628

NPI assigned

Mar 24, 2023

Organization subpart

No

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

Authorized official

Name

Meredith Raque, LCPC, ATR-BC

Title

Owner, Professional Counselor

Phone

(502) 554-4666

Specialties & licenses 1

Addresses

Practitioners 1

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

• Meredith Yebra, LCPC, ART-BC

  • Professional Counselor
  • Chicago, IL
  • NPI 1437718632
  NPD

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

{
    "created_epoch": "1679616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704326400000",
    "number": "1699478990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4610 N CLARK ST # 1203",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404620",
            "telephone_number": "312-278-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3124 W LOGAN BLVD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606471627",
            "telephone_number": "312-278-7628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MY ART THERAPY STUDIO, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-24",
        "last_updated": "2024-01-04",
        "certification_date": "2023-03-24",
        "status": "A",
        "authorized_official_last_name": "RAQUE",
        "authorized_official_first_name": "MEREDITH",
        "authorized_official_title_or_position": "OWNER, PROFESSIONAL COUNSELOR",
        "authorized_official_telephone_number": "502-554-4666",
        "authorized_official_credential": "LCPC, ATR-BC"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Chicago, IL
• Providers in Chicago, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; 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.