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General NPI Number Information
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NPI Number | 1902243090
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Entity Type | Organization
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Legal Business Name | LIFE RESET SOLUTIONS, P.C.
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Dates
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Enumeration Date | 05/29/2013
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Last Update Date | 10/21/2013
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Provider Practice Location Address
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Address Line | 3633 W LAKE AVE SUITE 404
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City | GLENVIEW
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State | IL
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Zip | 60026-5805
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Country | US
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Telephone | 312-285-4729
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Fax |
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Provider Business Mailing Address
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Address Line | 2675 N GREENWOOD AVE
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-8430
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Country | US
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Telephone | 312-285-4729
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. JANINE GAUTHIER MULLADY
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Credential | PHD
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Telephone | 312-285-4729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 071006689
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License Number State | IL
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