Provider Demographics
NPI:1104702513
Name:GRACE STREET COUNSELING PLLC
Entity type:Organization
Organization Name:GRACE STREET COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEVINSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:847-421-9007
Mailing Address - Street 1:3807 N LEAVITT ST
Mailing Address - Street 2:APT G
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618
Mailing Address - Country:US
Mailing Address - Phone:847-421-9007
Mailing Address - Fax:847-421-9007
Practice Address - Street 1:3807 N LEAVITT ST
Practice Address - Street 2:APT G
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618
Practice Address - Country:US
Practice Address - Phone:847-421-9007
Practice Address - Fax:847-421-9007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty