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General NPI Number Information
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NPI Number | 1831888171
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Entity Type | Organization
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Legal Business Name | RISE CONSULTING AND PSYCHOLOGICAL SERVICES LLC.
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Dates
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Enumeration Date | 05/03/2023
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 6323 N AVONDALE AVE STE 245B
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City | CHICAGO
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State | IL
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Zip | 60631-1999
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Country | US
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Telephone | 312-248-1647
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Fax |
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Provider Business Mailing Address
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Address Line | 1305 GLENRIDGE CT N
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City | MINOOKA
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State | IL
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Zip | 60447-4572
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Country | US
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Telephone | 937-248-3320
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MISS KARMEN CLAY
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Credential | PYSYD
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Telephone | 937-248-3320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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