MEDICARE: RESERVOIR RESOURCES 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
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1255416046	OTHER		NPI

General Provider Information

NPI Number	:	1932791571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RESERVOIR RESOURCES PLLC

Provider Business Mailing Address
First Line	:	2650 W MONTROSE AVE STE 207
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1674
Country	:	US
Telephone Number	:	872-201-1290
Fax Number	:

Provider Business Practice Location Address
First Line	:	2650 W MONTROSE AVE STE 207
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-1674
Country	:	US
Telephone Number	:	708-431-1504
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOY E ESHLEMAN
Credential	:	MA
Telephone Number	:	872-201-1290

Provider Enumeration Date	:	02/04/2021
Last Update Date	:	04/02/2021

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Directions to “RESERVOIR RESOURCES PLLC ” Practice Location

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