Healthcare Provider Details

I. General information

NPI: 1639438211
Provider Name (Legal Business Name): HEURISTIC HEALING HUMANITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9453 S. ASHLAND AVE SUITE 3
CHICAGO IL
60620-5105
US

IV. Provider business mailing address

1708 W BEVERLY GLEN PKWY
CHICAGO IL
60643-2127
US

V. Phone/Fax

Practice location:
  • Phone: 773-238-5555
  • Fax: 773-238-5533
Mailing address:
  • Phone: 773-405-1035
  • Fax: 773-238-5533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number13958
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178-007097
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-005158
License Number StateIL

VIII. Authorized Official

Name: MRS. PAULETTE R EASON-WILLIAMS
Title or Position: PARTNER
Credential: LCPC CADC
Phone: 773-405-1035