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General NPI Number Information
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NPI Number | 1518588334
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Entity Type | Organization
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Legal Business Name | SEASONS WITHIN LLC
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Dates
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Enumeration Date | 05/04/2020
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Last Update Date | 05/04/2020
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Provider Practice Location Address
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Address Line | 1515 N HARLEM AVE STE 301
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City | OAK PARK
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State | IL
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Zip | 60302-1205
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Country | US
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Telephone | 708-704-1934
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 N HARLEM AVE STE 301
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City | OAK PARK
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State | IL
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Zip | 60302-1205
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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 | PARTNER
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Name | KATHERINE KAMHOLZ
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Credential |
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Telephone | 708-704-1934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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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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