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General NPI Number Information
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NPI Number | 1174168108
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Entity Type | Organization
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Legal Business Name | C.M.M., LLC
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | 5225 OLD ORCHARD RD STE 14
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City | SKOKIE
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State | IL
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Zip | 60077-1027
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Country | US
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Telephone | 731-227-2278
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Fax |
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Provider Business Mailing Address
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Address Line | 1312 W BIRCHWOOD AVE APT 3
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City | CHICAGO
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State | IL
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Zip | 60626-1856
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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
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Name | CARLY MALETICH
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Credential | LCPC
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Telephone | 731-227-2278
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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 |
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License Number State |
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