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General NPI Number Information
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NPI Number | 1053110734
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Entity Type | Organization
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Legal Business Name | WEST SUBURBS OCD AND MENTAL HEALTH THERAPY LLC
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Dates
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Enumeration Date | 03/13/2025
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 913 62ND ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-1902
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Country | US
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Telephone | 630-201-0681
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Fax |
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Provider Business Mailing Address
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Address Line | 913 62ND ST
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City | DOWNERS GROVE
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State | IL
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Zip | 60516-1902
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Country | US
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Telephone | 630-201-0681
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GIA DONOFRIO-BALLIA
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Credential | LCPC
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Telephone | 630-201-0681
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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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