Healthcare Provider Details

I. General information

NPI: 1780233940
Provider Name (Legal Business Name): ESPERANZA CLINIC FOR BEHAVIORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2019
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 W NORTHWEST HWY STE 114
MOUNT PROSPECT IL
60056-2272
US

IV. Provider business mailing address

1100 W NORTHWEST HWY STE 114
MOUNT PROSPECT IL
60056-2272
US

V. Phone/Fax

Practice location:
  • Phone: 847-749-1104
  • Fax: 847-749-1104
Mailing address:
  • Phone: 847-749-1104
  • Fax: 847-749-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: PAULA KARNICK
Title or Position: AGENT
Credential: PHD ANP-BC
Phone: 847-749-1104