Provider Demographics
NPI:1891502555
Name:BUILD QUALITY LIFE
Entity type:Organization
Organization Name:BUILD QUALITY LIFE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARSON
Authorized Official - Middle Name:D
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:LPCP
Authorized Official - Phone:312-447-9906
Mailing Address - Street 1:360 E SOUTH WATER ST # 1681
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-4028
Mailing Address - Country:US
Mailing Address - Phone:312-447-9906
Mailing Address - Fax:
Practice Address - Street 1:360 E SOUTH WATER ST # 1681
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-4028
Practice Address - Country:US
Practice Address - Phone:312-447-9906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty