Provider Demographics
NPI:1033519707
Name:ETERNITYS PATH LLC A COUNSELING AND FAMILY RESOURCE CENTER
Entity Type:Organization
Organization Name:ETERNITYS PATH LLC A COUNSELING AND FAMILY RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JSHAUNTAE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-276-5155
Mailing Address - Street 1:444 N MICHIGAN AVE STE 1200
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3959
Mailing Address - Country:US
Mailing Address - Phone:312-276-5155
Mailing Address - Fax:702-910-3231
Practice Address - Street 1:444 N MICHIGAN AVE STE 1200
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3959
Practice Address - Country:US
Practice Address - Phone:312-276-5155
Practice Address - Fax:702-910-3231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty