MEDICARE: GARDEN OF REFLECTION

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
1	101Y00000X	Counselor	180.008964	IL

General Provider Information

NPI Number	:	1881004695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDEN OF REFLECTION

Provider Business Mailing Address
First Line	:	6457 N BELL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-5453
Country	:	US
Telephone Number	:	773-850-7366
Fax Number	:	888-668-6550

Provider Business Practice Location Address
First Line	:	1200 W 35TH ST STE 5E5560
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-1305
Country	:	US
Telephone Number	:	773-850-7366
Fax Number	:	888-668-6550

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SILVIA AVILA
Credential	:
Telephone Number	:	773-850-7366

Provider Enumeration Date	:	05/01/2014
Last Update Date	:	05/01/2014

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Directions to “GARDEN OF REFLECTION ” Practice Location

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