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General NPI Number Information
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NPI Number | 1457748428
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Entity Type | Organization
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Legal Business Name | SIMPLY COUNSELING
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Dates
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Enumeration Date | 04/17/2015
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Last Update Date | 04/17/2015
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Provider Practice Location Address
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Address Line | 1557 SHERMAN AVE
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City | EVANSTON
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State | IL
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Zip | 60201-4836
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Country | US
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Telephone | 773-966-9363
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Fax |
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Provider Business Mailing Address
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Address Line | 1557 SHERMAN AVE
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City | EVANSTON
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State | IL
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Zip | 60201-4836
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AYHSA HAGENE
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Credential |
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Telephone | 773-966-9363
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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 | 180006973
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License Number State | IL
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