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General NPI Number Information
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NPI Number | 1184371809
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Entity Type | Organization
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Legal Business Name | PEACE LILY THERAPY, PLLC
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Dates
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Enumeration Date | 03/02/2022
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Last Update Date | 12/30/2022
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Provider Practice Location Address
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Address Line | 3144 N RIDGEWAY AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60618-6616
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Country | US
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Telephone | 828-337-3223
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Fax |
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Provider Business Mailing Address
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Address Line | 3144 N RIDGEWAY AVE APT 2
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City | CHICAGO
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State | IL
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Zip | 60618-6616
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Country | US
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Telephone | 828-337-3223
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | LILY PEIFER
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Credential | LCSW
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Telephone | 828-337-3223
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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