| Evergrace Therapy Llc | |
|
10104 S Utica Ave Evergreen Park IL 60805-3527 | |
| (304) 280-6360 | |
| Not Available |
| Full Name | Evergrace Therapy Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 10104 S Utica Ave, Evergreen Park, Illinois |
| Authorized Official Name and Position | Samantha M Vazquez (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 3042806360 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergrace Therapy Llc 10104 S Utica Ave Evergreen Park IL 60805-3527 Ph: (304) 280-6360 | Evergrace Therapy Llc 10104 S Utica Ave Evergreen Park IL 60805-3527 Ph: (304) 280-6360 |
| NPI Number | 1164292645 |
|---|---|
| Provider Enumeration Date | 01/04/2024 |
| Last Update Date | 01/04/2024 |
| Certification Date | 01/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164292645 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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