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NPI Code Detail

MEDICARE: CRYSTAL TORO MA

MEDICARE: CRYSTAL TORO MA
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1528537685
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL TORO MA
Provider Business Mailing Address
First Line : 1111 W LAKE COOK RD
Second Line :
City : BUFFALO GROVE
State : IL
Zip : 60089-1926
Country : US
Telephone Number : 847-353-1758
Fax Number :
Provider Business Practice Location Address
First Line : 210 N WOLF RD
Second Line :
City : WHEELING
State : IL
Zip : 60090-2922
Country : US
Telephone Number : 847-353-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2018
Last Update Date : 11/19/2018

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Directions to “ CRYSTAL TORO MA” Practice Location

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