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General NPI Number Information
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NPI Number | 1356174882
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Entity Type | Organization
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Legal Business Name | NURTURE AND THRIVE PSYCHOTHERAPY PLLC
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Dates
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Enumeration Date | 08/21/2024
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 5419 W LAWRENCE AVE
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City | CHICAGO
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State | IL
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Zip | 60630-3686
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Country | US
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Telephone | 312-869-9899
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Fax |
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Provider Business Mailing Address
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Address Line | 5615 W GIDDINGS ST
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City | CHICAGO
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State | IL
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Zip | 60630-3213
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Country | US
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Telephone | 614-580-7349
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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 | BRIGID M DAGENFIELD
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Credential | LCPC
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Telephone | 614-580-7349
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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