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General NPI Number Information
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NPI Number | 1043972854
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Entity Type | Organization
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Legal Business Name | POSITIVELY PSYCHED, PLLC
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Dates
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Enumeration Date | 10/08/2021
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Last Update Date | 12/22/2023
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Provider Practice Location Address
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Address Line | 17 N CATHERINE AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-5929
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Country | US
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Telephone | 630-244-2679
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Fax |
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Provider Business Mailing Address
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Address Line | 17 N CATHERINE AVE
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City | LA GRANGE
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State | IL
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Zip | 60525-5929
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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 | OFFICE ADMINISTRATOR
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Name | SCOTT LESTINA
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Credential |
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Telephone | 630-244-2679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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