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General NPI Number Information
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NPI Number | 1619493855
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Entity Type | Organization
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Legal Business Name | BRICOLAGE WELLNESS, LLC
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 477 E BUTTERFIELD RD STE 212
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City | LOMBARD
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State | IL
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Zip | 60148-4879
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Country | US
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Telephone | 630-866-5666
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Fax |
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Provider Business Mailing Address
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Address Line | 477 E BUTTERFIELD RD STE 212
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City | LOMBARD
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State | IL
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Zip | 60148-4879
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Country | US
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Telephone | 630-866-5666
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Fax |
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Authorized Official
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Title or Position | OWNER/ CLINICAL THERAPIST
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Name | DAWN M LEPRICH-GRAVES
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Credential | LCPC
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Telephone | 630-866-5666
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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 | 180010822
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License Number State | IL
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