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General NPI Number Information
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NPI Number | 1174055255
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Entity Type | Individual
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Provider Name | MOLLY TRIBOU
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Gender | Female
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Dates
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Enumeration Date | 03/29/2017
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Last Update Date | 03/29/2017
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Provider Practice Location Address
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Address Line | 1409 W CARROLL AVE
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City | CHICAGO
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State | IL
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Zip | 60607-1105
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Country | US
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Telephone | 773-312-0883
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Fax |
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Provider Business Mailing Address
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Address Line | 3819 N GREENVIEW AVE APT 3S
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City | CHICAGO
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State | IL
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Zip | 60613-2754
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Country | US
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Telephone | 219-616-4715
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 178011666
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License Number State | IL
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