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General NPI Number Information
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NPI Number | 1699296160
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Entity Type | Individual
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Provider Name | DAISY LEMUS
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Gender | Female
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 09/06/2017
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Provider Practice Location Address
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Address Line | 5341 W CERMAK RD
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City | CICERO
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State | IL
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Zip | 60804-2817
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Country | US
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Telephone | 708-656-6430
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Fax |
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Provider Business Mailing Address
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Address Line | 5408 S KEELER AVE
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City | CHICAGO
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State | IL
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Zip | 60632-4234
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | L52016091636
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License Number State | IL
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