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NPI Code Detail

MEDICARE: HOPE AND HEALING CENTER, LLC

MEDICARE: HOPE AND HEALING CENTER, LLC
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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1568052660
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOPE AND HEALING CENTER, LLC
Provider Business Mailing Address
First Line : 6631 S RACINE AVE UNIT 2
Second Line :
City : CHICAGO
State : IL
Zip : 60636-2909
Country : US
Telephone Number : 773-217-9368
Fax Number :
Provider Business Practice Location Address
First Line : 10725 S WESTERN AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60643-3217
Country : US
Telephone Number : 773-217-9368
Fax Number :
Authorized Official
Title or Position : PSYCHOTHERAPIST
Name : PAMELA K WILLIAMS
Credential : LCPC
Telephone Number : 773-217-9368
Provider Enumeration Date : 01/22/2021
Last Update Date : 01/22/2021

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Directions to “HOPE AND HEALING CENTER, LLC ” Practice Location

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