=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295559128
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALMAVIE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/07/2024
-----------------------------------------------------
Last Update Date | 11/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 41 E 8TH ST APT 3302
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60605-2479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-725-4677
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1429 LORETE LN
-----------------------------------------------------
City | NORTHBROOK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60062-5142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-414-0810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-FOUNDER
-----------------------------------------------------
Name | MR. JIN KIM
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-414-0810
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------