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General NPI Number Information
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NPI Number | 1508245598
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Entity Type | Organization
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Legal Business Name | CLARIDAD CLARITY FAMILY COUNSELING, LLC
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Dates
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Enumeration Date | 05/22/2015
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Last Update Date | 05/22/2015
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Provider Practice Location Address
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Address Line | 4860 N OAK PARK AVE
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City | CHICAGO
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State | IL
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Zip | 60656-4028
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Country | US
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Telephone | 773-412-2388
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Fax |
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Provider Business Mailing Address
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Address Line | 4860 N OAK PARK AVE
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City | CHICAGO
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State | IL
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Zip | 60656-4028
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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 | ROCIO REYES
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Credential |
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Telephone | 773-412-2388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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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 | 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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