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General NPI Number Information
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NPI Number | 1316688187
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Entity Type | Organization
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Legal Business Name | LENORA CLINICAL GROUP LLC
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 1926 N SAWYER AVE APT 1F
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City | CHICAGO
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State | IL
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Zip | 60647-4631
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Country | US
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Telephone | 847-902-7724
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Fax |
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Provider Business Mailing Address
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Address Line | 9150 PASEO DE VALENCIA ST
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City | FORT MYERS
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State | FL
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Zip | 33908-9665
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Country | US
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Telephone | 847-902-7724
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Fax |
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Authorized Official
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Title or Position | THERAPIST/OWNER
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Name | KRISTEN LENORA BAUER
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Credential | LCPC
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Telephone | 847-902-7724
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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 |
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License Number State |
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