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General NPI Number Information
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NPI Number | 1881306421
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Entity Type | Organization
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Legal Business Name | SCE PSYCHOTHERAPY
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 12/14/2022
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Provider Practice Location Address
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Address Line | 4401 N CLARK ST
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City | CHICAGO
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State | IL
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Zip | 60640-5466
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Country | US
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Telephone | 773-615-0958
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Fax |
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Provider Business Mailing Address
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Address Line | 3208 N HALSTED ST APT 2
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City | CHICAGO
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State | IL
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Zip | 60657-8994
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Country | US
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Telephone | 773-615-0958
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHANNON ELIZABETH
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Credential |
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Telephone | 773-615-0958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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