Healthcare Provider Details

I. General information

NPI: 1043174816
Provider Name (Legal Business Name): TORNEISHA SMILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14604 JOHN HUMPHREY DR
ORLAND PARK IL
60462-2642
US

IV. Provider business mailing address

7723 S CALUMET AVE
CHICAGO IL
60619-2926
US

V. Phone/Fax

Practice location:
  • Phone: 424-527-1873
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: