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General NPI Number Information
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NPI Number | 1245615582
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Entity Type | Organization
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Legal Business Name | COLLECTIVE HOPE, LLC
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 1142 W MADISON ST STE 406
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City | CHICAGO
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State | IL
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Zip | 60607-2191
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Country | US
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Telephone | 773-599-9746
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Fax |
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Provider Business Mailing Address
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Address Line | 1142 W MADISON ST STE 406
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City | CHICAGO
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State | IL
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Zip | 60607-2191
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Country | US
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Telephone | 773-599-9746
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | SUSAN DUMA
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Credential | PSYD
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Telephone | 330-697-6591
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071008670
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License Number State | IL
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