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General NPI Number Information
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NPI Number | 1326825464
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Entity Type | Organization
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Legal Business Name | EMOVERE THERAPY, PLLC
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 4311 N RAVENSWOOD AVE STE 203
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City | CHICAGO
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State | IL
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Zip | 60613-1192
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Country | US
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Telephone | 262-328-6139
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Fax |
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Provider Business Mailing Address
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Address Line | 4610 N CLARK ST # 1275
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City | CHICAGO
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State | IL
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Zip | 60640-4620
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Country | US
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Telephone | 262-328-6139
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Fax |
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Authorized Official
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Title or Position | OWNER & THERAPIST
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Name | LAUREN MULLIGAN
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Credential | LCSW, R-DMT
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Telephone | 262-328-6139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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