Healthcare Provider Details

I. General information

NPI: 1275228827
Provider Name (Legal Business Name): CPR COUNSELING LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 09/08/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1644 W HOWARD STREET
CHICAGO IL
60626
US

IV. Provider business mailing address

1737 BROWN AVE
EVANSTON IL
60201-3301
US

V. Phone/Fax

Practice location:
  • Phone: 847-917-1141
  • Fax:
Mailing address:
  • Phone: 847-917-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. CHARLES P ROBERTS II
Title or Position: PRESIDENT
Credential: LMFT
Phone: 847-917-1141