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NPI Code Detail

MEDICARE: COMPASSIONATE COUCH CHICAGO PLLC

MEDICARE: COMPASSIONATE COUCH CHICAGO PLLC
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 : 1841030913
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMPASSIONATE COUCH CHICAGO PLLC
Provider Business Mailing Address
First Line : 878 N PAULINA ST APT 2
Second Line :
City : CHICAGO
State : IL
Zip : 60622-5093
Country : US
Telephone Number : 515-817-3828
Fax Number :
Provider Business Practice Location Address
First Line : 1200 N ASHLAND AVE STE 500
Second Line : PMB 6094
City : CHICAGO
State : IL
Zip : 60622-8327
Country : US
Telephone Number : 515-817-3828
Fax Number :
Authorized Official
Title or Position : LCPC
Name : EZZA MELINA AHMAD MUSTAFFA
Credential : MED
Telephone Number : 515-817-3828
Provider Enumeration Date : 05/28/2024
Last Update Date : 06/25/2024

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Directions to “COMPASSIONATE COUCH CHICAGO PLLC ” Practice Location

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