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General NPI Number Information
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NPI Number | 1124752902
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Entity Type | Organization
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Legal Business Name | PERIDOT COUNSELING PLLC
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 661 W LAKE ST STE 2S
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City | CHICAGO
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State | IL
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Zip | 60661-1034
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Country | US
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Telephone | 708-998-2029
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Fax |
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Provider Business Mailing Address
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Address Line | 661 W LAKE ST STE 2S
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City | CHICAGO
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State | IL
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Zip | 60661-1034
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | SARAH M SCHAFFER
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Credential | LCPC
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Telephone | 708-998-2029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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