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General NPI Number Information
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NPI Number | 1003569542
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Entity Type | Organization
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Legal Business Name | TIKVAH CENTER FOR JEWISH RECOVERY AND HEALING NFP
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Dates
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Enumeration Date | 02/03/2022
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Last Update Date | 02/03/2022
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Provider Practice Location Address
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Address Line | 3320 DUNDEE RD
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City | NORTHBROOK
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State | IL
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Zip | 60062-2303
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Country | US
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Telephone | 847-917-7725
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Fax |
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Provider Business Mailing Address
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Address Line | 3320 DUNDEE RD
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City | NORTHBROOK
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State | IL
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Zip | 60062-2303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ROBERT JURY
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Credential | LCPC
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Telephone | 847-917-7725
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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