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General NPI Number Information
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NPI Number | 1679216469
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Entity Type | Organization
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Legal Business Name | PERSONAL ENRICHMENT THERAPY LLC
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Dates
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Enumeration Date | 04/19/2022
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Last Update Date | 04/19/2022
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Provider Practice Location Address
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Address Line | 164 DIVISION ST STE 714
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City | ELGIN
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State | IL
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Zip | 60120-5534
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Country | US
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Telephone | 224-366-0189
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Fax |
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Provider Business Mailing Address
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Address Line | 275 FERN DR
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City | ELK GROVE VILLAGE
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State | IL
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Zip | 60007-4013
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Country | US
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Telephone | 224-366-0189
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MS. JENA CLAUDIA YUEN
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Credential | LCPC
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Telephone | 224-366-0189
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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 | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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