Healthcare Provider Details

I. General information

NPI: 1265136147
Provider Name (Legal Business Name): KAPWA ART THERAPY AND COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3214 W LELAND AVE APT 1A
CHICAGO IL
60625-8575
US

IV. Provider business mailing address

3214 W LELAND AVE APT 1A
CHICAGO IL
60625-8575
US

V. Phone/Fax

Practice location:
  • Phone: 773-931-8897
  • Fax:
Mailing address:
  • Phone: 773-931-8897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name: FREDELYN CALLA
Title or Position: OWNER, THERAPIST
Credential: LCPC, ATR-BC
Phone: 773-931-8897