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General NPI Number Information
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NPI Number | 1205046521
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Entity Type | Individual
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Provider Name | PATRICE KAREN QUEHL M.A., LMFT, LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 1 E SUPERIOR ST STE 500
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City | CHICAGO
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State | IL
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Zip | 60611-2507
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Country | US
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Telephone | 312-208-5620
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Fax |
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Provider Business Mailing Address
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Address Line | 930 W AINSLIE ST APT 1
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City | CHICAGO
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State | IL
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Zip | 60640-3820
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Country | US
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Telephone | 312-208-5620
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149-008175
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.000542
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License Number State | IL
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