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General NPI Number Information
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NPI Number | 1215308341
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Entity Type | Organization
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Legal Business Name | DRAW IT OUT
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 10/15/2015
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Provider Practice Location Address
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Address Line | 2419 W GREENLEAF AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60645-3319
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Country | US
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Telephone | 773-764-1418
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Fax |
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Provider Business Mailing Address
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Address Line | 2419 W GREENLEAF AVE UNIT 1
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City | CHICAGO
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State | IL
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Zip | 60645-3319
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Country | US
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Telephone | 773-764-1418
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MICHELLE LYNNE DRUCKER
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Credential | L.C.P.C.
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Telephone | 773-885-4794
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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 | 180002400
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License Number State | IL
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