=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356794283
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BELINDA PRENDERGAST VENTURA LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/15/2016
-----------------------------------------------------
Last Update Date | 02/23/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 620 MANCHESTER AVE
-----------------------------------------------------
City | WESTCHESTER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60154-2714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-343-4414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10240 W ROOSEVELT RD UNIT 7096
-----------------------------------------------------
City | WESTCHESTER
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60154-2004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-343-4414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------