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General NPI Number Information
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NPI Number | 1699486209
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Entity Type | Organization
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Legal Business Name | STRIVE TO SERENITY, LLC
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Dates
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Enumeration Date | 12/06/2022
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Last Update Date | 12/06/2022
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Provider Practice Location Address
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Address Line | 7124 W GRAND AVE
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City | CHICAGO
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State | IL
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Zip | 60707-2805
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Country | US
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Telephone | 773-413-7534
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Fax |
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Provider Business Mailing Address
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Address Line | 4837 S PRAIRIE AVE APT 1
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City | CHICAGO
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State | IL
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Zip | 60615-1257
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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 | OWNER
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Name | MICHELE MIGHTY
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Credential |
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Telephone | 773-413-7534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083T0002X
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Taxonomy Name | Medical Toxicology (Preventive Medicine) Physician
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License Number |
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License Number State |
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