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General NPI Number Information
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NPI Number | 1508632712
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Entity Type | Organization
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Legal Business Name | E REYNOSO COUNSELING LLC
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Dates
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Enumeration Date | 11/29/2023
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Last Update Date | 11/29/2023
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Provider Practice Location Address
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Address Line | 4611 N RAVENSWOOD AVE STE 104
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City | CHICAGO
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State | IL
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Zip | 60640-7568
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Country | US
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Telephone | 773-307-0334
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Fax |
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Provider Business Mailing Address
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Address Line | 6714 W THORNDALE AVE
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City | CHICAGO
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State | IL
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Zip | 60631-3107
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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 | COUNSELOR
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Name | EMILY REYNOSO
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Credential | LCPC
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Telephone | 773-307-0334
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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 | 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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