| Mending Spot Pllc | |
|
11621 S Maplewood Ave Chicago IL 60655-1523 | |
| (773) 636-5774 | |
| Not Available |
| Full Name | Mending Spot Pllc |
|---|---|
| Speciality | Counselor - Professional |
| Location | 11621 S Maplewood Ave, Chicago, Illinois |
| Authorized Official Name and Position | Jacqueline Christine White (MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 7736365774 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mending Spot Pllc 11621 S Maplewood Ave Chicago IL 60655-1523 Ph: (773) 636-5774 | Mending Spot Pllc 11621 S Maplewood Ave Chicago IL 60655-1523 Ph: (773) 636-5774 |
| NPI Number | 1437900818 |
|---|---|
| Provider Enumeration Date | 04/01/2024 |
| Last Update Date | 08/28/2024 |
| Certification Date | 08/28/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437900818 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
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