Healthcare Provider Details

I. General information

NPI: 1699296160
Provider Name (Legal Business Name): DAISY LEMUS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 09/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5341 W CERMAK RD
CICERO IL
60804-2817
US

IV. Provider business mailing address

5408 S KEELER AVE
CHICAGO IL
60632-4234
US

V. Phone/Fax

Practice location:
  • Phone: 708-656-6430
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberL52016091636
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: