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General NPI Number Information
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NPI Number | 1306220256
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Entity Type | Organization
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Legal Business Name | SECOND STORIES THERAPEUTIC INTERVENTIONS
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Dates
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Enumeration Date | 07/09/2015
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Last Update Date | 07/14/2015
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Provider Practice Location Address
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Address Line | 1121 WARREN AVE 260A
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3570
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Country | US
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Telephone | 773-513-9414
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Fax |
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Provider Business Mailing Address
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Address Line | 1121 WARREN AVE 260A
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-3570
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Country | US
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Telephone | 773-513-9414
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SYDNEI WOODLY
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Credential | M.A. LCPC
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Telephone | 479-841-8786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180007268
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178008081
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180008261
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License Number State | IL
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