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General NPI Number Information
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NPI Number | 1609699743
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Entity Type | Organization
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Legal Business Name | UP YOUR GAME COUNSELING PLLC
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Dates
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Enumeration Date | 11/06/2024
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 4250 N MARINE DR STE 200
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City | CHICAGO
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State | IL
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Zip | 60613-1936
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Country | US
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Telephone | 312-373-0684
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Fax |
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Provider Business Mailing Address
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Address Line | 4250 N MARINE DR STE 200
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City | CHICAGO
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State | IL
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Zip | 60613-1936
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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 | CREDENTIALING CONTRACTOR
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Name | ELLIE FELDMANN
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Credential |
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Telephone | 773-789-8934
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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