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General NPI Number Information
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NPI Number | 1437694254
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Entity Type | Organization
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Legal Business Name | INNERSHINE ASSOCIATES, LLC
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 01/28/2019
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Provider Practice Location Address
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Address Line | 723 W 111TH ST
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City | CHICAGO
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State | IL
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Zip | 60628-3902
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Country | US
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Telephone | 312-218-8568
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Fax | 773-643-8649
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Provider Business Mailing Address
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Address Line | 7131 S. CONSTANCE AVE.
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City | CHICAGO
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State | IL
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Zip | 60649-2326
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Country | US
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Telephone | 312-218-8568
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Fax |
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Authorized Official
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Title or Position | CEO/CLINICAL THERAPIST
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Name | DR. JOAN D MCCOHNELL
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Credential | PH.D
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Telephone | 312-218-8568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 149.018437
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License Number State | IL
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