Healthcare Provider Details

I. General information

NPI: 1750894713
Provider Name (Legal Business Name): TAWANDA RENEE CAUSAY M.ED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N WELLS ST STE 400
CHICAGO IL
60610-7632
US

IV. Provider business mailing address

2135 S MICHIGAN AVE UNIT 604L
CHICAGO IL
60616-5078
US

V. Phone/Fax

Practice location:
  • Phone: 312-573-8860
  • Fax:
Mailing address:
  • Phone:
  • 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:
Title or Position:
Credential:
Phone: