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NPI Code Detail

MEDICARE: RAVENSWOOD COUNSELING CENTER CO

MEDICARE: RAVENSWOOD COUNSELING CENTER CO
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1992378616
Entity Type Code : Organization
Provider Name (Legal Business Name) : RAVENSWOOD COUNSELING CENTER CO
Provider Business Mailing Address
First Line : 4453 N ROCKWELL ST APT 1
Second Line :
City : CHICAGO
State : IL
Zip : 60625-3057
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4611 N RAVENSWOOD AVE STE 105
Second Line :
City : CHICAGO
State : IL
Zip : 60640-7569
Country : US
Telephone Number : 773-321-6410
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : MEGAN K BRENNAN
Credential :
Telephone Number : 773-895-2125
Provider Enumeration Date : 07/20/2021
Last Update Date : 07/20/2021

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Directions to “RAVENSWOOD COUNSELING CENTER CO ” Practice Location

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