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General NPI Number Information
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NPI Number | 1639987258
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Entity Type | Organization
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Legal Business Name | PEACEFULLY ADJACENT THERAPY & WELLNESS PLLC
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Dates
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Enumeration Date | 12/28/2024
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Last Update Date | 12/28/2024
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Provider Practice Location Address
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Address Line | 20303 S. CRAWFORD AVE UNIT 210
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461
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Country | US
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Telephone | 708-549-9046
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Fax |
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Provider Business Mailing Address
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Address Line | 6811 167TH ST RM 4
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City | TINLEY PARK
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State | IL
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Zip | 60477-2501
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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 | OWNER/MANAGER
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Name | SIEDA J HILL
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Credential | LCSW
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Telephone | 773-428-7466
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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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