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General NPI Number Information
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NPI Number | 1376472415
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Entity Type | Organization
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Legal Business Name | INNER WISDOM THERAPY
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Dates
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Enumeration Date | 05/15/2026
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Last Update Date | 05/15/2026
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Provider Practice Location Address
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Address Line | 3432 W DIVERSEY AVE FL 2
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City | CHICAGO
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State | IL
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Zip | 60647-1221
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Country | US
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Telephone | 312-380-1747
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Fax |
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Provider Business Mailing Address
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Address Line | 3432 W DIVERSEY AVE FL 2
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City | CHICAGO
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State | IL
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Zip | 60647-1221
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Country | US
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Telephone | 312-380-1747
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTY QUEROL
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Credential |
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Telephone | 786-325-3006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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