Healthcare Provider Details

I. General information

NPI: 1821538752
Provider Name (Legal Business Name): PURE HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2017
Last Update Date: 02/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 W CORTLAND ST 3
CHICAGO IL
60647-4305
US

IV. Provider business mailing address

2451 W CORTLAND ST 3
CHICAGO IL
60647-4305
US

V. Phone/Fax

Practice location:
  • Phone: 415-336-4439
  • Fax:
Mailing address:
  • Phone: 415-336-4439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180010754
License Number StateIL

VIII. Authorized Official

Name: EMILY WOODS
Title or Position: OWNER/PSYCHOTHERAPIST
Credential: LCPC
Phone: 312-324-4502