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General NPI Number Information
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NPI Number | 1508310830
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Entity Type | Organization
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Legal Business Name | XAIA BODYMIND WELLNESS SUITE, LLC
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Dates
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Enumeration Date | 08/03/2016
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Last Update Date | 08/03/2016
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Provider Practice Location Address
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Address Line | 3525 W PETERSON AVE STE 607
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City | CHICAGO
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State | IL
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Zip | 60659-3318
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Country | US
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Telephone | 773-531-8513
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Fax |
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Provider Business Mailing Address
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Address Line | 5316 N CHRISTIANA AVE
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City | CHICAGO
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State | IL
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Zip | 60625-4710
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Country | US
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Telephone | 773-531-8513
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | FRANCINE KELLEY
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Credential | LCPC
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Telephone | 773-531-8513
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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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