=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699336784
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CORE COUNSELING INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2019
-----------------------------------------------------
Last Update Date | 06/27/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2835 N SHEFFIELD AVE STE 222
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60657-5083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-669-7521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4659 N CAMPBELL AVE UNIT 3
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60625-2936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-480-8249
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | KATHERINE HIBEY
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 312-480-8249
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0850X
-----------------------------------------------------
Taxonomy Name | Adult Mental Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------