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NPI Code Detail

MEDICARE: LINCOLN PARK THERAPY GROUP

MEDICARE: LINCOLN PARK THERAPY GROUP
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist166000873IL

General Provider Information

NPI Number : 1144672908
Entity Type Code : Organization
Provider Name (Legal Business Name) : LINCOLN PARK THERAPY GROUP
Provider Business Mailing Address
First Line : 2755 N PINE GROVE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-6109
Country : US
Telephone Number : 312-259-2665
Fax Number :
Provider Business Practice Location Address
First Line : 2755 N PINE GROVE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-6109
Country : US
Telephone Number : 312-259-2665
Fax Number :
Authorized Official
Title or Position : OWNER/PSYCHOTHERAPIST
Name : MRS. NICOLLE ALODIA MOLINA OSEQUEDA
Credential : LMFT
Telephone Number : 312-259-2665
Provider Enumeration Date : 07/05/2016
Last Update Date : 01/25/2021

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Directions to “LINCOLN PARK THERAPY GROUP ” Practice Location

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