Healthcare Provider Details

I. General information

NPI: 1093403396
Provider Name (Legal Business Name): INNER NOORI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 N OAK PARK AVE STE 215
OAK PARK IL
60301-1340
US

IV. Provider business mailing address

137 N OAK PARK AVE STE 215
OAK PARK IL
60301-1340
US

V. Phone/Fax

Practice location:
  • Phone: 630-474-8128
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DIMA DAIRANIEH
Title or Position: THERAPIST/OWNER
Credential: LCSW CADC
Phone: 630-474-8128