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Contact Information

AGAVE STUDIO FOR PSYCHOTHERAPY AND SPIRITUAL DIRECTION
2950 W CHICAGO AVE
#302
CHICAGO, IL60622-4375
 Phone: 773-627-2112
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Clinical

103TC0700X 62 Psychologist, Clinical
 

Counselor

101Y00000X
 

Pastoral

101YP1600X
Indicates primary specialty

NPI Profile & details for AGAVE STUDIO FOR PSYCHOTHERAPY AND SPIRITUAL DIRECTION · (Female)

NPI # 1093079212
Status Active
Credentials
Entity Individual
Enumeration date 07/02/2012
Last updated 07/02/2012 - About 14 years ago
Sole proprietor 1 Not specified
Identifiers
  • IL License # 071.008116
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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