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General NPI Number Information
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NPI Number | 1427478668
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Entity Type | Organization
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Legal Business Name | MARTIRENA THERAPY AND COUNSELING INC.
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Dates
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Enumeration Date | 04/25/2014
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Last Update Date | 04/25/2014
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Provider Practice Location Address
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Address Line | 10540 S WESTERN AVE SUITE 200
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City | CHICAGO
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State | IL
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Zip | 60643-2536
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Country | US
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Telephone | 773-319-8138
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Fax | 773-614-8078
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Provider Business Mailing Address
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Address Line | 10459 S MAPLEWOOD AVE
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City | CHICAGO
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State | IL
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Zip | 60655-1024
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Country | US
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Telephone | 773-319-8138
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Fax | 773-614-8078
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL CLINICAL COUN
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Name | LISA MARIE MARTIRENA
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Credential | LCPC, MT-BC
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Telephone | 773-319-8138
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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 | 180008411
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License Number State | IL
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