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General NPI Number Information
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NPI Number | 1073831525
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Entity Type | Organization
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Legal Business Name | BEVERLY GROUP MHS, INC.
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Dates
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Enumeration Date | 05/07/2010
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Last Update Date | 05/07/2010
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Provider Practice Location Address
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Address Line | 53 W JACKSON BLVD SUITE 1705
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City | CHICAGO
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State | IL
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Zip | 60604-3606
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Country | US
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Telephone | 773-490-0576
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Fax |
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Provider Business Mailing Address
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Address Line | 4444 S BERKELEY AVE
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City | CHICAGO
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State | IL
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Zip | 60653-3610
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Country | US
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Telephone | 773-490-0576
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MS. LATRICE FOULES
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Credential | MSW
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Telephone | 708-906-7912
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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 | 149.010964
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License Number State | IL
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