Healthcare Provider Details

I. General information

NPI: 1487844700
Provider Name (Legal Business Name): AUDREY L. PARSLEY L.C.P.C., D.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5650 N SHERIDAN RD 16G
CHICAGO IL
60660-4879
US

IV. Provider business mailing address

5650 N SHERIDAN RD 16G
CHICAGO IL
60660-4879
US

V. Phone/Fax

Practice location:
  • Phone: 773-944-9055
  • Fax: 773-944-9066
Mailing address:
  • Phone: 773-944-9055
  • Fax: 773-944-9066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.006248
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1521719
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: