Healthcare Provider Details

I. General information

NPI: 1265176689
Provider Name (Legal Business Name): SAMUEL LOUIS-PIERRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 07/24/2022
Certification Date: 07/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 N MARION ST STE 211
OAK PARK IL
60302-1872
US

IV. Provider business mailing address

429 N MARION ST STE 211
OAK PARK IL
60302-1872
US

V. Phone/Fax

Practice location:
  • Phone: 774-678-1505
  • Fax:
Mailing address:
  • Phone: 774-678-1505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: