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General NPI Number Information
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NPI Number | 1518731470
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Entity Type | Organization
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Legal Business Name | INSIGHT OUT THERAPY & WELLNESS, LLC
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Dates
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Enumeration Date | 11/10/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 5330 S PRAIRIE AVE APT 3S
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City | CHICAGO
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State | IL
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Zip | 60615-4726
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Country | US
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Telephone | 815-766-1298
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 815-766-1298
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | MS. BIANCA HERNANDEZ
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Credential | LCPC
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Telephone | 815-766-1298
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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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