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General NPI Number Information
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NPI Number | 1114575669
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Entity Type | Organization
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Legal Business Name | GROWING BOUNDLESSLY LLC
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 332 S. MICHIGAN AVE. SUITE 121 #5589
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City | CHICAGO
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State | IL
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Zip | 60604
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Country | US
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Telephone | 312-577-7258
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Fax |
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Provider Business Mailing Address
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Address Line | 332 S MICHIGAN AVE STE 121
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City | CHICAGO
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State | IL
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Zip | 60604-4302
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Country | US
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Telephone | 312-577-7258
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Fax |
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Authorized Official
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Title or Position | LCPC
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Name | AMARI JACKSON
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Credential |
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Telephone | 312-577-7258
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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 |
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License Number State |
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