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General NPI Number Information
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NPI Number | 1053609289
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Entity Type | Individual
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Provider Name | BETH CHUNG M.S.
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Gender | Female
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Dates
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Enumeration Date | 07/21/2011
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Last Update Date | 12/18/2020
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Provider Practice Location Address
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Address Line | 4803 N. MILWAUKEE AVE SUITE B, UNIT 218
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City | CHICAGO
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State | IL
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Zip | 60630-1563
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Country | US
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Telephone | 773-318-4085
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Fax |
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Provider Business Mailing Address
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Address Line | 4803 N. MILWAUKEE AVE SUITE B, UNIT 218
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City | CHICAGO
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State | IL
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Zip | 60630-2146
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.000947
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License Number State | IL
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