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General NPI Number Information
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NPI Number | 1174845291
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Entity Type | Organization
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Legal Business Name | MARY AND TOM LEO ASSOCIATES, INC.
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Dates
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Enumeration Date | 02/16/2010
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Last Update Date | 02/16/2010
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Provider Practice Location Address
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Address Line | 2656 W MONTROSE AVE
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City | CHICAGO
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State | IL
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Zip | 60618-1559
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Country | US
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Telephone | 773-267-5795
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Fax | 773-267-4787
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Provider Business Mailing Address
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Address Line | 2656 W MONTROSE AVE
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City | CHICAGO
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State | IL
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Zip | 60618-1559
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Country | US
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Telephone | 773-267-5795
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Fax | 773-267-4787
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Authorized Official
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Title or Position | DIRECTOR OF CLINICAL SERVICES
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Name | MS. MOIRA BAKER
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Credential | MSW
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Telephone | 773-267-5795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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