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General NPI Number Information
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NPI Number | 1710861471
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Entity Type | Organization
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Legal Business Name | ALYSE MALMBORG THERAPY PLLC
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Dates
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Enumeration Date | 08/04/2025
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 2155 W BELMONT AVE # 1071
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City | CHICAGO
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State | IL
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Zip | 60618-6471
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Country | US
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Telephone | 773-250-7177
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Fax |
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Provider Business Mailing Address
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Address Line | 2155 W BELMONT AVE # 1071
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City | CHICAGO
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State | IL
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Zip | 60618-6471
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Country | US
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Telephone | 773-250-7177
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | TIARA EDWARDS
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Credential |
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Telephone | 323-404-5212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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