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General NPI Number Information
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NPI Number | 1295082295
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Entity Type | Organization
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Legal Business Name | SPRINGTIDES, INC.
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Dates
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Enumeration Date | 08/08/2012
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Last Update Date | 08/08/2012
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Provider Practice Location Address
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Address Line | 2400 N LAKEVIEW AVE #1703
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City | CHICAGO
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State | IL
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Zip | 60614-2739
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Country | US
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Telephone | 312-282-2610
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 N LAKEVIEW AVE #1703
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City | CHICAGO
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State | IL
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Zip | 60614-2739
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Country | US
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Telephone | 312-282-2610
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. LAURA MARGARET SZWALEK
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Credential | LCPC
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Telephone | 312-282-2610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 180008213
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License Number State | IL
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