Healthcare Provider Details

I. General information

NPI: 1437682937
Provider Name (Legal Business Name): OBSIDIAN INSTITUTE OF INTEGRATIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4718 147TH ST
MIDLOTHIAN IL
60445-2527
US

IV. Provider business mailing address

4718 147TH ST
MIDLOTHIAN IL
60445-2527
US

V. Phone/Fax

Practice location:
  • Phone: 708-704-0489
  • Fax: 888-592-0804
Mailing address:
  • Phone: 708-462-2134
  • Fax: 888-592-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ERICA WASHINGTON
Title or Position: DIRECTOR OF OPERATIONS
Credential: MA, LCPC, LMHC, NCC
Phone: 708-462-2134