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General NPI Number Information
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NPI Number | 1861088643
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Entity Type | Organization
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Legal Business Name | CORAL HEART COUNSELING, LLC
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 320 W OHIO ST STE 3W
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City | CHICAGO
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State | IL
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Zip | 60654-7887
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Country | US
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Telephone | 708-433-9363
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Fax |
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Provider Business Mailing Address
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Address Line | 320 W OHIO ST STE 3W
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City | CHICAGO
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State | IL
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Zip | 60654-7887
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Country | US
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Telephone | 708-433-9363
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | OLIVIA TAYLOR
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Credential | LCSW
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Telephone | 773-790-3738
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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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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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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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Taxonomy #6
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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