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General NPI Number Information
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NPI Number | 1457645673
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Entity Type | Organization
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Legal Business Name | ON THE MARK CONSULTING
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Dates
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Enumeration Date | 06/06/2011
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Last Update Date | 06/06/2011
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Provider Practice Location Address
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Address Line | 3170 N SHERIDAN RD SUITE 807
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City | CHICAGO
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State | IL
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Zip | 60657-4830
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Country | US
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Telephone | 773-549-7914
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Fax |
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Provider Business Mailing Address
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Address Line | 3170 N SHERIDAN RD SUITE 807
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City | CHICAGO
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State | IL
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Zip | 60657-4830
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Country | US
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Telephone | 773-549-7914
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Fax |
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Authorized Official
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Title or Position | THERAPIST, PRIVATE PRACTICE
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Name | MR. MARK A. SANDERS
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Credential | MSW, LCSW
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Telephone | 773-549-7914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149002148
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License Number State | IL
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