Healthcare Provider Details

I. General information

NPI: 1013735562
Provider Name (Legal Business Name): ODETA ESPINOZA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 W BUTTERFIELD RD STE LLB
ELMHURST IL
60126-5024
US

IV. Provider business mailing address

GRACE INTEGRATED LLC 414 PLAZA DR STE 301
WESTMONT IL
60559
US

V. Phone/Fax

Practice location:
  • Phone: 630-474-8919
  • Fax:
Mailing address:
  • Phone: 630-728-1744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178016064
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: