Healthcare Provider Details

I. General information

NPI: 1154593473
Provider Name (Legal Business Name): SALVADOR G. MOROTE SANCHEZ PSY.D., M.A., LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10001 GRAND AVE
FRANKLIN PARK IL
60131-2563
US

IV. Provider business mailing address

5030 W DAKIN ST
CHICAGO IL
60641-2608
US

V. Phone/Fax

Practice location:
  • Phone: 847-451-0330
  • Fax:
Mailing address:
  • Phone: 773-725-8432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.006242
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.006242
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number180.006242
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number180.006242
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: