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General NPI Number Information
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NPI Number | 1326858820
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Entity Type | Organization
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Legal Business Name | INTERLUDE HEALING COLLECTIVE LLC
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 11/19/2025
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Provider Practice Location Address
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Address Line | 935 175TH ST STE 309
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City | HOMEWOOD
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State | IL
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Zip | 60430-2073
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Country | US
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Telephone | 708-918-4839
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Fax | 312-284-1426
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Provider Business Mailing Address
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Address Line | 935 175TH ST STE 309
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City | HOMEWOOD
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State | IL
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Zip | 60430-2073
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Country | US
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Telephone | 708-918-4839
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Fax | 312-284-1426
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Authorized Official
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Title or Position | CEO
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Name | MISS MELYSSA SCOTT
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Credential | LCSW
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Telephone | 708-979-3984
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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