=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861986291
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEARTH FIRE COUNSELING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2018
-----------------------------------------------------
Last Update Date | 06/19/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 N MICHIGAN AVE STE 704
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60601-3905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-707-0633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 N MICHIGAN AVE STE 704
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60601-3905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 224-707-0633
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DENNIS NGUYEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 224-707-0633
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149019184
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------