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General NPI Number Information
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NPI Number | 1063689404
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Entity Type | Organization
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Legal Business Name | SUNA MATARIEH AND ASSOCIATES PC
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Dates
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Enumeration Date | 05/14/2008
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Last Update Date | 05/14/2008
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Provider Practice Location Address
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Address Line | 7059 W 111TH ST SUITE B
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City | WORTH
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State | IL
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Zip | 60482-1826
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Country | US
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Telephone | 708-557-1112
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Fax |
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Provider Business Mailing Address
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Address Line | 7059 W 111TH ST
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City | WORTH
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State | IL
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Zip | 60482-1826
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Country | US
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Telephone | 708-557-1112
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Fax |
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Authorized Official
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Title or Position | PROFESSIONAL COUNSELOR/PRESIDENT
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Name | MRS. SANA MATARIEH
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Credential | L.C.P.C.
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Telephone | 708-557-1112
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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 | 180.006236
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License Number State | IL
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