Healthcare Provider Details

I. General information

NPI: 1427776335
Provider Name (Legal Business Name): KAIZEN OR NO ZEN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CHATHAM RD STE N
SPRINGFIELD IL
62704-4188
US

IV. Provider business mailing address

1440 W TAYLOR ST # 785
CHICAGO IL
60607-4623
US

V. Phone/Fax

Practice location:
  • Phone: 314-596-2805
  • Fax:
Mailing address:
  • Phone: 314-596-2805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA SNELL
Title or Position: LCSW/OWNER
Credential:
Phone: 314-596-2805