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General NPI Number Information
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NPI Number | 1356626683
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Entity Type | Organization
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Legal Business Name | MARY K HORAN LCSW, LLC
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Dates
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Enumeration Date | 10/18/2011
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Last Update Date | 10/18/2011
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Provider Practice Location Address
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Address Line | 2625 BUTTERFIELD RD SUITE 138S
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City | OAK BROOK
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State | IL
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Zip | 60523-1234
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Country | US
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Telephone | 708-508-9981
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Fax |
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Provider Business Mailing Address
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Address Line | 312 WISCONSIN AVE # 1N
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City | OAK PARK
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State | IL
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Zip | 60302-3494
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Country | US
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Telephone | 708-508-9981
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | MARY HORAN
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Credential |
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Telephone | 708-508-9981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149013501
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License Number State | IL
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