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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

NPI Number 1093079212
LBN Legal business name AGAVE STUDIO FOR PSYCHOTHERAPY AND SPIRITUAL DIRECTION
Authorized official JANEIL RUIZ - (EXECUTIVE DIRECTOR AND FOUNDER)
Entity Organization
Organization subpart 1 No
Enumeration date 07/02/2012
Last updated 07/02/2012 - About 14 years ago
Identifiers
IL License # 071.008116
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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