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General NPI Number Information
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NPI Number | 1285181438
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Entity Type | Organization
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Legal Business Name | THE CIRCLE EL CIRCULO OF THE SOCIETY OF HELPERS
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 2648 W PERSHING RD
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City | CHICAGO
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State | IL
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Zip | 60632-1629
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Country | US
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Telephone | 872-444-5148
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Fax | 872-444-5148
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Provider Business Mailing Address
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Address Line | 2648 W PERSHING RD
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City | CHICAGO
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State | IL
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Zip | 60632-1629
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Country | US
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Telephone | 872-444-5148
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Fax | 872-444-5148
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ALICIA GUTIERREZ
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Credential | MS
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Telephone | 872-444-5148
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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 | 071-002095
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071002095
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License Number State | IL
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