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General NPI Number Information
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NPI Number | 1972092476
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Entity Type | Organization
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Legal Business Name | BODY WISDOM COUNSELING PLLC
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 1502 W CHICAGO AVE STE 1
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City | CHICAGO
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State | IL
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Zip | 60642
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Country | US
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Telephone | 872-256-0962
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Fax |
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Provider Business Mailing Address
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Address Line | 1502 W CHICAGO AVE STE 1
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City | CHICAGO
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State | IL
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Zip | 60642-5236
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHERISH HAMILTON-TEKAUTZ
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Credential | LCSW
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Telephone | 872-256-0962
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.018323
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License Number State | IL
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