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General NPI Number Information
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NPI Number | 1881413748
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Entity Type | Organization
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Legal Business Name | ONE HOPE UNITED NORTHERN REGION
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 3077 W JEFFERSON ST STE 105
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City | JOLIET
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State | IL
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Zip | 60435-5263
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Country | US
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Telephone | 815-730-6700
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Fax |
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Provider Business Mailing Address
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Address Line | 3077 W JEFFERSON ST STE 105
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City | JOLIET
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State | IL
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Zip | 60435-5263
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Country | US
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Telephone | 815-730-6700
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, BEHAVIORAL HEALTH
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Name | HEATHER CHRISTINE KELLY
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Credential | LCSW
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Telephone | 217-273-5398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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