Healthcare Provider Details

I. General information

NPI: 1518588334
Provider Name (Legal Business Name): SEASONS WITHIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 N HARLEM AVE STE 301
OAK PARK IL
60302-1205
US

IV. Provider business mailing address

1515 N HARLEM AVE STE 301
OAK PARK IL
60302-1205
US

V. Phone/Fax

Practice location:
  • Phone: 708-704-1934
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE KAMHOLZ
Title or Position: PARTNER
Credential:
Phone: 708-704-1934