=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801577556
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AID
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2023
-----------------------------------------------------
Last Update Date | 09/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 525 N EDGELAWN DR
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60506-4327
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-801-1109
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 309 NEW INDIAN TRAIL CT
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60506-2411
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-966-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MHP
-----------------------------------------------------
Name | KELLY L RAMIREZ
-----------------------------------------------------
Credential | MHP
-----------------------------------------------------
Telephone | 630-966-4000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------