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General NPI Number Information
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NPI Number | 1457131716
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Entity Type | Individual
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Provider Name | ANDREA IBARRA
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Gender | Female
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Dates
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Enumeration Date | 10/04/2023
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Last Update Date | 10/04/2023
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Provider Practice Location Address
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Address Line | 333 N MICHIGAN AVE STE 1530
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City | CHICAGO
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State | IL
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Zip | 60601-4000
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Country | US
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Telephone | 312-248-4930
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Fax |
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Provider Business Mailing Address
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Address Line | 2941 W 25TH PL
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City | CHICAGO
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State | IL
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Zip | 60623-4116
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Country | US
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Telephone | 773-673-4193
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 178.019330
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License Number State | IL
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