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General NPI Number Information
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NPI Number | 1386009009
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Entity Type | Organization
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Legal Business Name | ASHLEY ALLIS LLC
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Dates
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Enumeration Date | 12/22/2015
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Last Update Date | 11/30/2016
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Provider Practice Location Address
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Address Line | 708 CHURCH ST SUITE 221
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City | EVANSTON
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State | IL
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Zip | 60201-3875
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Country | US
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Telephone | 262-215-6506
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Fax |
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Provider Business Mailing Address
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Address Line | 708 CHURCH ST SUITE 221
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City | EVANSTON
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State | IL
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Zip | 60201-3875
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Country | US
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Telephone | 262-215-6506
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | ASHLEY ALLIS
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Credential | LCPC
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Telephone | 262-215-6506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180009592
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License Number State | IL
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