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General NPI Number Information
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NPI Number | 1235460189
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Entity Type | Organization
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Legal Business Name | CORE CENTERS, LLC
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Dates
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Enumeration Date | 01/15/2010
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Last Update Date | 01/15/2010
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Provider Practice Location Address
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Address Line | 205 N MICHIGAN AVE STE. 301
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City | CHICAGO
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State | IL
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Zip | 60601-5927
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Country | US
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Telephone | 312-540-9955
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Fax | 312-540-0944
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Provider Business Mailing Address
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Address Line | 205 N MICHIGAN AVE STE. 301
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City | CHICAGO
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State | IL
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Zip | 60601-5927
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Country | US
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Telephone | 312-540-9955
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Fax | 312-540-0944
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Authorized Official
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Title or Position | CO-DIRECTOR
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Name | MRS. JENNY CONVISER
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Credential | PSY.D
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Telephone | 312-540-9955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 071005162
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 071004492
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License Number State | IL
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