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General NPI Number Information
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NPI Number | 1467120378
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Entity Type | Organization
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Legal Business Name | RECLAIM YOUR JOY
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 1644 N HONORE ST
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City | CHICAGO
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State | IL
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Zip | 60622-1538
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Country | US
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Telephone | 773-294-1924
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Fax |
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Provider Business Mailing Address
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Address Line | 644 W GRACE ST
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City | CHICAGO
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State | IL
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Zip | 60613-5384
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Country | US
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Telephone | 773-294-1924
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | KERRY ITO
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Credential | MA, LCPC
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Telephone | 773-294-1924
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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 |
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License Number State |
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