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General NPI Number Information
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NPI Number | 1982249850
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Entity Type | Organization
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Legal Business Name | CHRYSANTHEMUM COUNSELING, LTD
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Dates
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Enumeration Date | 11/14/2019
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Last Update Date | 11/14/2019
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Provider Practice Location Address
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Address Line | 10725 S WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60643-3135
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Country | US
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Telephone | 630-674-2504
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Fax |
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Provider Business Mailing Address
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Address Line | 4877 N KENMORE AVE APT 3
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City | CHICAGO
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State | IL
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Zip | 60640-3742
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Country | US
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Telephone | 630-674-2504
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | BENJAMIN WALKER
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Credential | LCSW
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Telephone | 630-674-2504
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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 |
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License Number State |
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