=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104582832
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE ESSENCE OF HEALING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2021
-----------------------------------------------------
Last Update Date | 11/17/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4051 W KAMERLING AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60651-1941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-643-1016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4051 W KAMERLING AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60651-1941
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-643-1016
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/CLINICAL THERAPIST
-----------------------------------------------------
Name | DR. LA TOYA LYNN PATTERSON
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 847-643-1016
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------