Provider Demographics
NPI:1285387928
Name:PEACEFUL CHAOS PLLC
Entity type:Organization
Organization Name:PEACEFUL CHAOS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANEQUIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYMORE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:872-243-9945
Mailing Address - Street 1:3431 ATTICA RD
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1307
Mailing Address - Country:US
Mailing Address - Phone:872-243-9945
Mailing Address - Fax:
Practice Address - Street 1:3431 ATTICA RD
Practice Address - Street 2:
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1307
Practice Address - Country:US
Practice Address - Phone:872-243-9945
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty