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General NPI Number Information
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NPI Number | 1932241627
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Entity Type | Organization
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Legal Business Name | INSTITUTE FOR MOTIVATIONAL DEVELOPMENT OF ILLINOIS LTD
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 05/16/2008
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Provider Practice Location Address
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Address Line | 10 E 22ND ST STE 210
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City | LOMBARD
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State | IL
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Zip | 60148-6108
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Country | US
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Telephone | 630-627-5000
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Fax | 630-627-5032
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Provider Business Mailing Address
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Address Line | 10 E 22ND ST STE 210
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City | LOMBARD
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State | IL
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Zip | 60148-6108
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Country | US
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Telephone | 630-627-5000
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Fax | 630-627-5032
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Authorized Official
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Title or Position | DIRECTOR
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Name | CHERYL ZEPEDA
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Credential | MS, LPC
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Telephone | 630-627-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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