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General NPI Number Information
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NPI Number | 1376169284
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Entity Type | Organization
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Legal Business Name | EWELINA BEARDMORE PSYCHOTHERAPY LLC
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 1700 W IRVING PARK RD STE 301
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City | CHICAGO
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State | IL
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Zip | 60613-2462
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Country | US
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Telephone | 312-217-6072
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Fax |
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Provider Business Mailing Address
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Address Line | 1700 W IRVING PARK RD STE 301
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City | CHICAGO
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State | IL
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Zip | 60613-2462
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Country | US
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Telephone | 312-217-6072
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Fax | 312-327-7123
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Authorized Official
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Title or Position | OWNER & PSYCHOTHERAPIST
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Name | MRS. EWELINA BEARDMORE
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Credential | LCPC
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Telephone | 312-217-6072
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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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