Healthcare Provider Details

I. General information

NPI: 1427727858
Provider Name (Legal Business Name): WITH OPEN ARMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2021
Last Update Date: 01/21/2023
Certification Date: 01/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 HARRISON ST # 2W
OAK PARK IL
60304-1350
US

IV. Provider business mailing address

638 HARRISON ST # 2W
OAK PARK IL
60304-1350
US

V. Phone/Fax

Practice location:
  • Phone: 708-797-3111
  • Fax:
Mailing address:
  • Phone: 708-797-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JESSICA WASHINGTON
Title or Position: THERAPIST
Credential: LCPC
Phone: 773-663-1224