Healthcare Provider Details

I. General information

NPI: 1982318838
Provider Name (Legal Business Name): BEATRIZ ELENA PRIETO GARZA MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4939 W FULLERTON AVE
CHICAGO IL
60639-2505
US

IV. Provider business mailing address

115 GARFIELD ST APT 2A
OAK PARK IL
60304-2200
US

V. Phone/Fax

Practice location:
  • Phone: 708-683-9725
  • Fax:
Mailing address:
  • Phone: 956-280-9067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180016958
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: