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General NPI Number Information
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NPI Number | 1861165573
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Entity Type | Organization
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Legal Business Name | MENTAL HEALTH THERAPY, SEX THERAPY PLLC
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Dates
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Enumeration Date | 07/28/2021
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Last Update Date | 07/28/2021
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Provider Practice Location Address
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Address Line | 3505 N KOLMAR AVE FL 2
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City | CHICAGO
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State | IL
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Zip | 60641-3825
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Country | US
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Telephone | 872-216-1763
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Fax |
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Provider Business Mailing Address
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Address Line | 3505 N KOLMAR AVE FL 2
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City | CHICAGO
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State | IL
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Zip | 60641-3825
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Country | US
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Telephone | 872-216-1763
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | DR. STACEY LYNN SKOWRONSKI
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Credential | PHD, LCSW, CST
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Telephone | 872-216-1763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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