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General NPI Number Information
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NPI Number | 1619767670
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Entity Type | Organization
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Legal Business Name | VELVET & VINE LLC
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Dates
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Enumeration Date | 05/12/2025
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 1357 W ARGYLE ST APT 3C
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City | CHICAGO
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State | IL
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Zip | 60640-8412
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Country | US
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Telephone | 817-896-2707
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Fax |
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Provider Business Mailing Address
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Address Line | 112 E BURLINGTON AVE STE 519
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City | LA GRANGE
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State | IL
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Zip | 60525-2481
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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 | PRACTICE MANAGEMENT COORDINATOR
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Name | BENJAMIN J SAUER
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Credential |
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Telephone | 414-607-2553
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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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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Taxonomy #5
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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