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General NPI Number Information
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NPI Number | 1588315733
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Entity Type | Organization
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Legal Business Name | MIND'S EYE PSYCHOTHERAPY AND CONSULTATION, PLLC
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Dates
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Enumeration Date | 01/10/2022
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Last Update Date | 01/10/2022
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Provider Practice Location Address
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Address Line | 1715 W ROSCOE ST
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City | CHICAGO
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State | IL
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Zip | 60657-1015
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Country | US
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Telephone | 847-337-9899
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Fax |
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Provider Business Mailing Address
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Address Line | 1715 W ROSCOE ST
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City | CHICAGO
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State | IL
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Zip | 60657-1015
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Country | US
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Telephone | 847-337-9899
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | SHARON STECKLER
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Credential | LCSW
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Telephone | 847-337-9899
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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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