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General NPI Number Information
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NPI Number | 1730431156
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Entity Type | Organization
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Legal Business Name | MICHAEL HEARD
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Dates
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Enumeration Date | 10/09/2012
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Last Update Date | 01/16/2013
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Provider Practice Location Address
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Address Line | 8643 S MARSHFIELD AVE
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City | CHICAGO
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State | IL
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Zip | 60620-4846
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Country | US
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Telephone | 773-239-8463
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Fax |
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Provider Business Mailing Address
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Address Line | 8643 S. MARSHFIELD STREET
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City | CHICAGO
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State | IL
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Zip | 60620
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Country | US
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Telephone | 773-239-8463
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. MICHAEL LAMAR HEARD
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Credential | LCSW
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Telephone | 773-316-8275
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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 | 149.006014
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License Number State | IL
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