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General NPI Number Information
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NPI Number | 1518692672
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Entity Type | Organization
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Legal Business Name | HGC THERAPY LTD.
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Dates
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Enumeration Date | 07/21/2022
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3850 W 93RD ST
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-1819
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Country | US
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Telephone | 708-710-1693
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Fax |
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Provider Business Mailing Address
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Address Line | 3850 W 93RD ST
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City | EVERGREEN PARK
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State | IL
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Zip | 60805-1819
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Country | US
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Telephone | 708-710-1693
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KATHLEEN MONROE
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Credential | LCSW, CADC
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Telephone | 708-710-1693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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