MEDICARE: CENTER FOR INTUITIVE GROWTH AND HEALING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103T00000X	Psychologist
2	1041C0700X	Clinical Social Worker
3	106H00000X	Marriage & Family Therapist
4	101Y00000X	Counselor
5	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023583754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR INTUITIVE GROWTH AND HEALING

Provider Business Mailing Address
First Line	:	9519 S TRUMBULL AVE
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-3058
Country	:	US
Telephone Number	:	708-200-1306
Fax Number	:	708-907-3729

Provider Business Practice Location Address
First Line	:	10540 S WESTERN AVE STE 314
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-2529
Country	:	US
Telephone Number	:	708-200-1306
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANA LILIA JAVIER-ETAPA
Credential	:	LCPC
Telephone Number	:	708-200-1306

Provider Enumeration Date	:	10/09/2018
Last Update Date	:	01/03/2023

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Directions to “CENTER FOR INTUITIVE GROWTH AND HEALING ” Practice Location

Language	Start Address	Practice Location

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