=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528571668
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASCEND COUNSELING & WELLNES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2017
-----------------------------------------------------
Last Update Date | 11/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8941 S WESTERN AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60643-6432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-340-7769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 611 E 89TH ST
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60619-6829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-514-6873
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNSELOR/OWNER
-----------------------------------------------------
Name | TERAKESHA HAMMOND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 708-514-6873
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 180009417
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------