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General NPI Number Information
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NPI Number | 1780233940
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Entity Type | Organization
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Legal Business Name | ESPERANZA CLINIC FOR BEHAVIORAL HEALTH LLC
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Dates
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Enumeration Date | 09/10/2019
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Last Update Date | 09/10/2019
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Provider Practice Location Address
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Address Line | 1100 W NORTHWEST HWY STE 114
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-2272
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Country | US
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Telephone | 847-749-1104
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Fax | 847-749-1104
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Provider Business Mailing Address
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Address Line | 1100 W NORTHWEST HWY STE 114
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City | MOUNT PROSPECT
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State | IL
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Zip | 60056-2272
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Country | US
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Telephone | 847-749-1104
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Fax | 847-749-1104
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Authorized Official
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Title or Position | AGENT
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Name | PAULA KARNICK
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Credential | PHD ANP-BC
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Telephone | 847-749-1104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number |
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License Number State |
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