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General NPI Number Information
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NPI Number | 1740728500
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Entity Type | Organization
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Legal Business Name | ENTOURAGE CLINICAL SERVICES, INC
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Dates
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Enumeration Date | 02/01/2017
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Last Update Date | 02/23/2017
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Provider Practice Location Address
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Address Line | 697 S LAKE ST
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City | MUNDELEIN
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State | IL
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Zip | 60060-3658
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Country | US
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Telephone | 847-406-0789
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Fax |
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Provider Business Mailing Address
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Address Line | 37 BURNETT AVE
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City | LAKE VILLA
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State | IL
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Zip | 60046-8670
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Country | US
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Telephone | 847-393-5646
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. MELANIE E DILLON
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Credential | LCPC, NCC, CADC
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Telephone | 847-393-5646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 172P00000X
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Taxonomy Name | Naprapath
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 174V00000X
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Taxonomy Name | Clinical Ethicist
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 175F00000X
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Taxonomy Name | Naturopath
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 246RP1900X
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Taxonomy Name | Phlebotomy Technician
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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