Healthcare Provider Details

I. General information

NPI: 1962827964
Provider Name (Legal Business Name): CARMEN OCHOA-GALINDO ED.D, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 12/26/2019
Certification Date: 12/26/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 N MOBILE AVE PCC COMMUNITY WELLNESS CENTER
CHICAGO IL
60634-4041
US

IV. Provider business mailing address

3030 N MOBILE AVE PCC COMMUNITY WELLNESS CENTER
CHICAGO IL
60634-4041
US

V. Phone/Fax

Practice location:
  • Phone: 773-622-5679
  • Fax:
Mailing address:
  • Phone: 773-622-5679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.008360
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: