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General NPI Number Information
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NPI Number | 1679040745
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Entity Type | Organization
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Legal Business Name | THIRD COAST WELLNESS
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Dates
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Enumeration Date | 10/26/2018
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 1300 W BELMONT AVE STE 407A
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City | CHICAGO
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State | IL
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Zip | 60657-3242
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Country | US
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Telephone | 312-560-9005
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 W BELMONT AVE STE 407A
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City | CHICAGO
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State | IL
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Zip | 60657-3242
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Country | US
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Telephone | 312-560-9005
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. ALISON KRAMME
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Credential | LCPC
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Telephone | 312-560-9005
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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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