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General NPI Number Information
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NPI Number | 1205647419
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Entity Type | Organization
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Legal Business Name | MFBSTUDIO INC
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Dates
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Enumeration Date | 01/16/2025
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 475 W 55TH ST STE 108
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-3565
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Country | US
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Telephone | 708-688-9171
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Fax |
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Provider Business Mailing Address
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Address Line | 6055 W 64TH ST
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City | CHICAGO
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State | IL
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Zip | 60638-5307
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Country | US
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Telephone | 773-710-4428
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Fax |
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Authorized Official
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Title or Position | OWNER/ LCPC PROVIDER
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Name | MARY FRANCE BAZAN
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Credential | LCPC
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Telephone | 708-688-9171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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