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General NPI Number Information
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NPI Number | 1851918908
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Entity Type | Organization
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Legal Business Name | LIESER COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 07/05/2020
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Last Update Date | 07/05/2020
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Provider Practice Location Address
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Address Line | 1122 W CATALPA AVE STE 1W
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City | CHICAGO
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State | IL
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Zip | 60640-7023
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Country | US
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Telephone | 773-706-8277
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Fax | 773-326-3797
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Provider Business Mailing Address
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Address Line | 4848 N SHERIDAN RD APT 308
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City | CHICAGO
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State | IL
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Zip | 60640-6976
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Country | US
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Telephone | 773-706-8277
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Fax | 773-326-3797
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. MATTHEW JOSEPH LIESER
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Credential | LCPC
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Telephone | 773-706-8277
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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 |
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