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General NPI Number Information
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NPI Number | 1003600511
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Entity Type | Organization
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Legal Business Name | MIRACLEWORKS THERAPY & CONSULTING INC
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Dates
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Enumeration Date | 04/08/2025
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 51 E 14TH ST APT 1008
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City | CHICAGO
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State | IL
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Zip | 60605-2998
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Country | US
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Telephone | 310-849-4786
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Fax | 872-250-2826
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Provider Business Mailing Address
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Address Line | 51 E 14TH ST APT 1008
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City | CHICAGO
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State | IL
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Zip | 60605-2998
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Country | US
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Telephone | 310-849-4786
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Fax | 872-250-2826
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MIRACLE D MONTGOMERY
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Credential | LCSW
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Telephone | 310-849-4786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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