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General NPI Number Information
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NPI Number | 1871118711
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Entity Type | Individual
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Provider Name | PARISA LYNN GHEBLEH LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/16/2020
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 1220 S WOOD ST
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City | CHICAGO
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State | IL
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Zip | 60608-1202
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Country | US
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Telephone | 312-355-7553
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 12TH AVE S STE 901
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City | SEATTLE
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State | WA
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Zip | 98144-2712
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Country | US
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Telephone | 206-548-3114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 149022276
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LW61326933
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License Number State | WA
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