=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134837651
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATTERNS & CHOICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2022
-----------------------------------------------------
Last Update Date | 11/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9631 S CICERO AVE STE 1511
-----------------------------------------------------
City | OAK LAWN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60453-3137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-417-6806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9631 S CICERO AVE STE 1511
-----------------------------------------------------
City | OAK LAWN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60453-3137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-417-6806
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LCPC / PSYCHOTHERAPIST
-----------------------------------------------------
Name | LAKEISHA NOWICKI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 773-417-6806
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------