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General NPI Number Information
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NPI Number | 1225889090
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Entity Type | Organization
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Legal Business Name | BUNATALK THERAPY, LLC
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Dates
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Enumeration Date | 03/29/2024
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 1323 W JEFFERSON ST
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City | JOLIET
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State | IL
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Zip | 60435-6862
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Country | US
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Telephone | 630-384-9114
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Fax |
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Provider Business Mailing Address
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Address Line | 1323 W JEFFERSON ST
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City | JOLIET
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State | IL
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Zip | 60435-6862
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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 | OWNER
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Name | BETHLEHEM HAILU
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Credential | LCSW
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Telephone | 630-788-0707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | 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 | 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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