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General NPI Number Information
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NPI Number | 1588179386
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Entity Type | Organization
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Legal Business Name | TRIUMPH SEMINARS
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Dates
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Enumeration Date | 12/04/2017
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Last Update Date | 12/04/2017
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Provider Practice Location Address
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Address Line | 1310 W 64TH ST
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City | CHICAGO
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State | IL
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Zip | 60636-2913
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Country | US
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Telephone | 773-912-6967
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Fax | 844-492-3952
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Provider Business Mailing Address
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Address Line | 1310 W 64TH ST
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City | CHICAGO
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State | IL
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Zip | 60636-2913
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Country | US
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Telephone | 773-912-6967
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Fax | 844-492-3952
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Authorized Official
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Title or Position | FOUNDER, EXECUTIVE DIRECTOR
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Name | MRS. AUDREA FUMBANKS NANABRAY
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Credential | PHD, LCSW
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Telephone | 630-825-9673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.019056
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License Number State | IL
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