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General NPI Number Information
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NPI Number | 1659814192
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Entity Type | Organization
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Legal Business Name | EATING RECOVERY CENTER
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Dates
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Enumeration Date | 12/01/2016
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 150 E HURON ST SUITE 1200
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City | CHICAGO
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State | IL
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Zip | 60611-2999
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Country | US
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Telephone | 312-964-4617
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 N LINCOLN PARK W UNIT 1212
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City | CHICAGO
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State | IL
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Zip | 60614-3456
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Country | US
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Telephone | 630-649-8772
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Fax |
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Authorized Official
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Title or Position | PRIMARY THERAPIST II
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Name | MRS. COLLEEN MARY WATSON
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Credential | LCPC
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Telephone | 312-964-4617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 201543752
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License Number State | IL
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