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General NPI Number Information
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NPI Number | 1114053766
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Entity Type | Individual
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Provider Name | JOSHUA SMITH HETHERINGTON MSMFT
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 1770 W BERTEAU AVE
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City | CHICAGO
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State | IL
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Zip | 60613-1849
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Country | US
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Telephone | 773-791-0469
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Fax |
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Provider Business Mailing Address
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Address Line | 1138 W NORTH SHORE AVE APT 1S
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City | CHICAGO
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State | IL
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Zip | 60626-4664
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Country | US
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Telephone | 773-791-0469
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180-003937
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166-000557
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License Number State | IL
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