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General NPI Number Information
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NPI Number | 1184120933
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Entity Type | Organization
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Legal Business Name | MEG EIFRIG, LLC
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 04/02/2018
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Provider Practice Location Address
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Address Line | 1010 JORIE BLVD STE 364
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City | OAK BROOK
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State | IL
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Zip | 60523-3000
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Country | US
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Telephone | 773-558-9380
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 JORIE BLVD STE 364
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City | OAK BROOK
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State | IL
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Zip | 60523-3000
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Country | US
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Telephone | 773-558-9380
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MEG EIFRIG
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Credential | LCPC
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Telephone | 773-558-9380
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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 | 180010134
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License Number State | IL
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