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General NPI Number Information
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NPI Number | 1669144218
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Entity Type | Organization
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Legal Business Name | IMAGINE THERAPY MINDFULNESS HEALING PLLC
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Dates
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Enumeration Date | 10/01/2021
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Last Update Date | 10/01/2021
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Provider Practice Location Address
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Address Line | 708 W GRAND AVE
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City | CHICAGO
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State | IL
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Zip | 60654
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Country | US
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Telephone | 312-300-2190
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Fax |
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Provider Business Mailing Address
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Address Line | 708 W GRAND AVE
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City | CHICAGO
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State | IL
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Zip | 60654
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Country | US
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Telephone | 312-300-2190
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | CHRISSA FLANNERY
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Credential |
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Telephone | 708-337-0642
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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 | 104100000X
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Taxonomy Name | Social Worker
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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 | 207PH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Emergency Medicine) Physician
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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