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General NPI Number Information
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NPI Number | 1790318301
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Entity Type | Organization
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Legal Business Name | NEST PSYCHOTHERAPY PLLC
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Dates
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Enumeration Date | 02/21/2020
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Last Update Date | 07/27/2022
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Provider Practice Location Address
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Address Line | 4633 N WESTERN AVE SUITE 200
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City | CHICAGO
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State | IL
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Zip | 60625-2181
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Country | US
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Telephone | 847-348-9849
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Fax |
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Provider Business Mailing Address
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Address Line | 4633 N WESTERN AVE SUITE 200
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City | CHICAGO
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State | IL
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Zip | 60625-2181
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST, OWNER
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Name | JOANNA VILLACORTA GRIFFIN
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Credential | LCSW
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Telephone | 847-348-9849
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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