Healthcare Provider Details

I. General information

NPI: 1487991337
Provider Name (Legal Business Name): URBAN BRAIN AND BODY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2013
Last Update Date: 01/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2551 N CLARK ST 8TH FLOOR
CHICAGO IL
60614-1798
US

IV. Provider business mailing address

2551 N CLARK ST 8TH FLOOR
CHICAGO IL
60614-1798
US

V. Phone/Fax

Practice location:
  • Phone: 312-257-8550
  • Fax:
Mailing address:
  • Phone: 312-257-8550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. SETH ELLIOTT FRANZ
Title or Position: OWNER
Credential:
Phone: 312-257-8550