Healthcare Provider Details

I. General information

NPI: 1801425335
Provider Name (Legal Business Name): HIGHER GROUND WELLNESS GROUP LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2020
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date: 11/08/2024
Reactivation Date: 12/09/2024

III. Provider practice location address

1053 LAKE ST STE 3
OAK PARK IL
60301-1144
US

IV. Provider business mailing address

1053 LAKE ST STE 3
OAK PARK IL
60301-1144
US

V. Phone/Fax

Practice location:
  • Phone: 773-317-2056
  • Fax:
Mailing address:
  • Phone: 773-317-2056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
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: FELICIA M OWENS
Title or Position: PRESIDENT
Credential: PSY.D
Phone: 773-317-2056