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General NPI Number Information
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NPI Number | 1962068957
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Entity Type | Individual
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Provider Name | LAURA BENTLEY
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Gender | Female
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Dates
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Enumeration Date | 05/15/2019
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Last Update Date | 05/20/2019
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Provider Practice Location Address
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Address Line | 610 S MAPLE AVE STE 5601
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City | OAK PARK
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State | IL
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Zip | 60304-1091
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Country | US
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Telephone | 773-665-8052
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Fax |
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Provider Business Mailing Address
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Address Line | 6531 W DICKENS AVE 2E
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City | CHICAGO
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State | IL
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Zip | 60707
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Country | US
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Telephone | 630-251-6172
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178011578
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.012263
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License Number State | IL
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