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General NPI Number Information
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NPI Number | 1548752355
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Entity Type | Organization
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Legal Business Name | COFFEE TALK COUNSELING, INC.
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Dates
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Enumeration Date | 06/06/2018
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Last Update Date | 06/06/2018
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Provider Practice Location Address
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Address Line | 3528 N ASHLAND AVE
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City | CHICAGO
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State | IL
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Zip | 60657-1314
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Country | US
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Telephone | 773-250-1774
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Fax |
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Provider Business Mailing Address
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Address Line | 1242 W PRATT BLVD APT 3F
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City | CHICAGO
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State | IL
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Zip | 60626-4354
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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 | OWNER
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Name | SHARON ELLO
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Credential | LCSW
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Telephone | 630-699-2747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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