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General NPI Number Information
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NPI Number | 1689337214
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Entity Type | Organization
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Legal Business Name | AUTUMN HOUSE COUNSELING PLLC
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Dates
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Enumeration Date | 10/20/2021
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 18300 S HALSTED ST STE B #214
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City | GLENWOOD
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State | IL
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Zip | 60425-1051
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Country | US
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Telephone | 773-679-0986
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Fax |
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Provider Business Mailing Address
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Address Line | 18300 S HALSTED ST STE B #214
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City | GLENWOOD
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State | IL
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Zip | 60425-1051
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Country | US
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Telephone | 773-679-0986
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Fax |
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Authorized Official
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Title or Position | OWNER, COUNSELOR
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Name | SANDRA RODRIGUEZ
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Credential | MA, LCPC
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Telephone | 773-679-0986
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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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