Healthcare Provider Details

I. General information

NPI: 1083571632
Provider Name (Legal Business Name): CHUNLI LIU MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2216 S WENTWORTH AVE
CHICAGO IL
60616-2012
US

IV. Provider business mailing address

2216 S WENTWORTH AVE
CHICAGO IL
60616-2012
US

V. Phone/Fax

Practice location:
  • Phone: 312-328-7451
  • Fax:
Mailing address:
  • Phone: 312-328-7451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.022164
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: