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General NPI Number Information
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NPI Number | 1710263488
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Entity Type | Organization
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Legal Business Name | CONSULTATION KARES LLC
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Dates
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Enumeration Date | 10/26/2011
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 514 E 50TH PL
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City | CHICAGO
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State | IL
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Zip | 60615-2466
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Country | US
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Telephone | 773-633-2151
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Fax |
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Provider Business Mailing Address
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Address Line | 6348 N MILWAUKEE AVE # 186
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City | CHICAGO
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State | IL
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Zip | 60646-3728
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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 | C.E.O
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Name | MS. KATJA AISHA MIMMS
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Credential | M.A., LPC
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Telephone | 312-504-9048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 178.007536
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License Number State | IL
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