Healthcare Provider Details

I. General information

NPI: 1902126139
Provider Name (Legal Business Name): TAMMY ROHAN BOBEL LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2010
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3317 W 95TH ST SUITE 202
EVERGREEN PARK IL
60805-2243
US

IV. Provider business mailing address

3317 W 95TH ST SUITE 202
EVERGREEN PARK IL
60805-2243
US

V. Phone/Fax

Practice location:
  • Phone: 708-529-3011
  • Fax:
Mailing address:
  • Phone: 708-529-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180008083
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178006174
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: