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General NPI Number Information
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NPI Number | 1609507144
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Entity Type | Organization
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Legal Business Name | PLUMERIA CENTER FOR THERAPY AND WELLNESS
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Dates
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Enumeration Date | 06/23/2022
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Last Update Date | 06/23/2022
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Provider Practice Location Address
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Address Line | 222 RACHEL CIR
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City | SYCAMORE
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State | IL
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Zip | 60178-1281
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Country | US
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Telephone | 608-931-3683
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Fax |
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Provider Business Mailing Address
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Address Line | 3230 SYCAMORE RD # 202
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City | DEKALB
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State | IL
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Zip | 60115-9621
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Country | US
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Telephone | 608-931-3683
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOLOGIST
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Name | ELIZABETH ANN GARCIA
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Credential | PHD
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Telephone | 608-931-3683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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