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General NPI Number Information
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NPI Number | 1043994478
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Entity Type | Organization
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Legal Business Name | CONNECTION CLINICAL SERVICES PLLC
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 2001 N HALSTED ST STE 203
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City | CHICAGO
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State | IL
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Zip | 60614-4365
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Country | US
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Telephone | 872-267-2427
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 N HALSTED ST STE 203
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City | CHICAGO
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State | IL
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Zip | 60614-4365
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Country | US
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Telephone | 872-267-2427
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | MARGARET HENSLEY KHOSHABA
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Credential | LMFT
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Telephone | 872-267-2427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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