Provider Demographics
NPI:1689551681
Name:JAY MEYTHALER PSYCHOTHERAPY PLLC
Entity type:Organization
Organization Name:JAY MEYTHALER PSYCHOTHERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JURGENT
Authorized Official - Middle Name:MEYTHALER
Authorized Official - Last Name:MEYTHALER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, CADC
Authorized Official - Phone:312-593-0419
Mailing Address - Street 1:53 W JACKSON BLVD STE 1440
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60604-3538
Mailing Address - Country:US
Mailing Address - Phone:312-553-9530
Mailing Address - Fax:312-235-1611
Practice Address - Street 1:53 W JACKSON BLVD STE 1440
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60604-3538
Practice Address - Country:US
Practice Address - Phone:312-553-9530
Practice Address - Fax:312-235-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No251B00000XAgenciesCase Management