Healthcare Provider Details

I. General information

NPI: 1336070804
Provider Name (Legal Business Name): MATY PATINO TREJO ALMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 W JACKSON BLVD STE 838
CHICAGO IL
60604-3611
US

IV. Provider business mailing address

53 W JACKSON BLVD STE 838
CHICAGO IL
60604-3611
US

V. Phone/Fax

Practice location:
  • Phone: 312-291-1730
  • Fax:
Mailing address:
  • Phone: 312-291-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number208.011623
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: