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General NPI Number Information
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NPI Number | 1932791571
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Entity Type | Organization
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Legal Business Name | RESERVOIR RESOURCES PLLC
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Dates
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Enumeration Date | 02/04/2021
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 2650 W MONTROSE AVE STE 207
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City | CHICAGO
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State | IL
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Zip | 60618-1674
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Country | US
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Telephone | 708-431-1504
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 W MONTROSE AVE STE 207
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City | CHICAGO
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State | IL
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Zip | 60618-1674
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Country | US
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Telephone | 872-201-1290
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOY E ESHLEMAN
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Credential | MA
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Telephone | 872-201-1290
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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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Taxonomy #2
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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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