=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689434516
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SELF COMPASSION COUNSELING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2024
-----------------------------------------------------
Last Update Date | 05/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 661 W LAKE ST STE 2S
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60661-1034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-828-1422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 661 W LAKE ST STE 2S
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60661-1034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-828-1422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOLE MEMBER
-----------------------------------------------------
Name | SHIRLEY KHONG
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 773-828-1422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------