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General NPI Number Information
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NPI Number | 1487912952
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Entity Type | Organization
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Legal Business Name | CARL ROY SCIANNA AND ASSOCIATES LLC
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Dates
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Enumeration Date | 05/02/2012
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Last Update Date | 05/02/2012
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Provider Practice Location Address
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Address Line | 1263 S HIGHLAND AVE STE 2D
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City | LOMBARD
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State | IL
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Zip | 60148-4527
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Country | US
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Telephone | 630-408-8108
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4143
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City | CHICAGO
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State | IL
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Zip | 60654-4143
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Country | US
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Telephone | 630-290-7762
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Fax |
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Authorized Official
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Title or Position | THERAPIST / PRESIDENT
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Name | MR. CARL ROY SCIANNA
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Credential |
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Telephone | 630-290-7762
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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 | 180.007794
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License Number State | IL
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