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General NPI Number Information
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NPI Number | 1972142198
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Entity Type | Organization
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Legal Business Name | CENTER FOR AUTHENTIC LIVING, INC.
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Dates
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Enumeration Date | 01/06/2020
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Last Update Date | 01/06/2020
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Provider Practice Location Address
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Address Line | 120 MAIN STREET SUITE 200
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City | PARK RIDGE
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State | IL
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Zip | 60068
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Country | US
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Telephone | 847-668-4869
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Fax | 847-728-5313
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Provider Business Mailing Address
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Address Line | 120 MAIN STREET SUITE 200
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City | PARK RIDGE
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State | IL
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Zip | 60068
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Country | US
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Telephone | 847-668-4869
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Fax | 847-728-5313
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY M SCHNITZIUS-RICHKO
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Credential | LCPC
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Telephone | 847-668-4869
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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 |
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License Number State |
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