Provider Demographics
NPI:1063981207
Name:NIA INTEGRATIVE HEALING
Entity type:Organization
Organization Name:NIA INTEGRATIVE HEALING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:708-228-9492
Mailing Address - Street 1:1122 WESTGATE ST STE 201A
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60301-1170
Mailing Address - Country:US
Mailing Address - Phone:708-228-9492
Mailing Address - Fax:
Practice Address - Street 1:1122 WESTGATE ST STE 201A
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1170
Practice Address - Country:US
Practice Address - Phone:708-228-9492
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)