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General NPI Number Information
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NPI Number | 1215398508
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Entity Type | Organization
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Legal Business Name | MAKE YOUR MARK THERAPY, LLC
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Dates
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Enumeration Date | 03/14/2016
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Last Update Date | 03/14/2016
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Provider Practice Location Address
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Address Line | 1608 W COLONIAL PKWY SUITE 207
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City | INVERNESS
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State | IL
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Zip | 60067-4755
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Country | US
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Telephone | 630-390-9833
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Fax |
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Provider Business Mailing Address
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Address Line | 1608 W COLONIAL PKWY SUITE 207
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City | INVERNESS
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State | IL
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Zip | 60067-4755
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICNESED CLINICAL COUNSELOR
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Name | KIRA MURPHY
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Credential | LCPC
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Telephone | 630-390-9833
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 180.008991
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License Number State | IL
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