MEDICARE: EMILY SIERRA CHURCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1215784319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY SIERRA CHURCH

Provider Business Mailing Address
First Line	:	3267 W WRIGHTWOOD AVE APT 3Y
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1622
Country	:	US
Telephone Number	:	702-912-8104
Fax Number	:

Provider Business Practice Location Address
First Line	:	3267 W WRIGHTWOOD AVE APT 3Y
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-1622
Country	:	US
Telephone Number	:	702-912-8104
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/06/2024
Last Update Date	:	05/06/2024

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Directions to “ EMILY SIERRA CHURCH ” Practice Location

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