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General NPI Number Information
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NPI Number | 1457212268
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Entity Type | Organization
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Legal Business Name | INTENTIONAL HEALING PSYCHIATRIC CENTER PLLC
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Dates
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Enumeration Date | 11/20/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 480 ELM PL STE 110
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2535
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Country | US
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Telephone | 708-223-2682
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Fax |
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Provider Business Mailing Address
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Address Line | 9631 S CICERO AVE # 1075
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City | OAK LAWN
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State | IL
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Zip | 60453-3137
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Country | US
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Telephone | 708-223-2682
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Fax | 708-265-2736
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JULIE LAND
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Credential | MD
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Telephone | 708-223-2682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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