Center For Self-Actualization
Counselor, Professional in Evergreen Park, IL. Organization (NPI-2).
NPI number1922423508
StatusActive
Last updated in NPPESFeb 19, 2014
Details
- NPI
- 1922423508
- Entity type
- Organization (NPI-2)
- Legal business name
- Center For Self-Actualization
- Organization subpart
- No
- Enumeration date
- Feb 19, 2014
- Last updated
- Feb 19, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 101YP2500X | Counselor, Professional | 180008083 | IL | Yes |
| 101YP2500X | Counselor, Professional | 180008956 | IL |
Practice location
3317 W 95th StSuite 101
Evergreen Park, IL 60805-2243
Phone 312-927-0216
Mailing address
3317 W 95th StSuite 101
Evergreen Park, IL 60805-2243
Phone 312-927-0216
Authorized official
Tammy Rohan Bobel
Director
3129270216
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