Healthcare Provider Details

I. General information

NPI: 1285036491
Provider Name (Legal Business Name): BREATHE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 04/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15255 S 94TH AVE
ORLAND PARK IL
60462-3800
US

IV. Provider business mailing address

329 W 102ND PL
CHICAGO IL
60628-1916
US

V. Phone/Fax

Practice location:
  • Phone: 847-461-8718
  • Fax: 847-485-5605
Mailing address:
  • Phone: 847-461-8718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180008522
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180008522
License Number StateIL
# 7
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.008522
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 9
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL
# 10
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number180008522
License Number StateIL

VIII. Authorized Official

Name: MS. WINIFRED BRADSHAW
Title or Position: DIRECTOR
Credential: CRC/LCPC
Phone: 847-461-8718