Provider Demographics
NPI:1265020267
Name:EVERSFIELD COUNSELING & THERAPY PLLC
Entity Type:Organization
Organization Name:EVERSFIELD COUNSELING & THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:AZAR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:414-736-1241
Mailing Address - Street 1:4331 N OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1619
Mailing Address - Country:US
Mailing Address - Phone:414-736-1241
Mailing Address - Fax:
Practice Address - Street 1:4201 N DAMEN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3021
Practice Address - Country:US
Practice Address - Phone:414-736-1241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty