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General NPI Number Information
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NPI Number | 1457879298
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Entity Type | Organization
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Legal Business Name | COVENANT INTUITION CENTER
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Dates
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Enumeration Date | 08/31/2017
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Last Update Date | 08/31/2017
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Provider Practice Location Address
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Address Line | 1 WESTBROOK CORPORATE CTR STE 300
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City | WESTCHESTER
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State | IL
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Zip | 60154-5709
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Country | US
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Telephone | 224-252-1490
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Fax |
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Provider Business Mailing Address
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Address Line | 1 WESTBROOK CORPORATE CTR STE 300
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City | WESTCHESTER
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State | IL
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Zip | 60154-5709
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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/CLINICIAN
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Name | COURTNEY S OSBOURNE
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Credential | LCPC
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Telephone | 224-252-1490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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