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General NPI Number Information
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NPI Number | 1467329250
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Entity Type | Organization
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Legal Business Name | LIBERATED YOU
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Dates
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Enumeration Date | 10/17/2025
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 2702 S HOMAN AVE
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City | CHICAGO
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State | IL
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Zip | 60623-4618
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Country | US
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Telephone | 708-710-3965
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Fax |
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Provider Business Mailing Address
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Address Line | 2702 S HOMAN AVE
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City | CHICAGO
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State | IL
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Zip | 60623-4618
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Country | US
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Telephone | 708-710-3965
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | ANGEL NICOLE TATUM
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Credential | LCSW
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Telephone | 708-710-3965
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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