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General NPI Number Information
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NPI Number | 1992204002
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Entity Type | Organization
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Legal Business Name | INNER HEALING PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 02/04/2018
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Last Update Date | 02/04/2018
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Provider Practice Location Address
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Address Line | 200 W MADISON ST STE 2100
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City | CHICAGO
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State | IL
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Zip | 60606-3521
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Country | US
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Telephone | 847-924-2094
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Fax |
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Provider Business Mailing Address
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Address Line | 200 W MADISON ST STE 2100
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City | CHICAGO
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State | IL
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Zip | 60606-3521
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Country | US
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Telephone | 847-924-2094
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHANIE MARIE QUIGLEY
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Credential | LCSW
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Telephone | 844-792-4209
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 149018204
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License Number State | IL
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