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General NPI Number Information
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NPI Number | 1760691620
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Entity Type | Organization
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Legal Business Name | AMANI TRINITY UNITED COMMUNITY HEALTH CORPORATION
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 532 W 95TH ST
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City | CHICAGO
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State | IL
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Zip | 60628-1122
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Country | US
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Telephone | 773-994-9937
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Fax | 773-994-9943
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Provider Business Mailing Address
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Address Line | 400 W 95TH ST
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City | CHICAGO
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State | IL
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Zip | 60628-1120
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Country | US
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Telephone | 773-994-9937
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Fax | 773-994-9943
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ETTA MCGREGOR JONES
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Credential | M.S.W.
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Telephone | 773-298-2110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | IL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | IL
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