Healthcare Provider Details

I. General information

NPI: 1023583754
Provider Name (Legal Business Name): CENTER FOR INTUITIVE GROWTH AND HEALING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2018
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10540 S WESTERN AVE STE 314
CHICAGO IL
60643-2529
US

IV. Provider business mailing address

9519 S TRUMBULL AVE
EVERGREEN PARK IL
60805-3058
US

V. Phone/Fax

Practice location:
  • Phone: 708-200-1306
  • Fax:
Mailing address:
  • Phone: 708-200-1306
  • Fax: 708-907-3729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANA LILIA JAVIER-ETAPA
Title or Position: OWNER
Credential: LCPC
Phone: 708-200-1306