Provider Demographics
NPI:1417675778
Name:ESSENTIAL LIFESTYLE THERAPY &CONSULTING LLC
Entity Type:Organization
Organization Name:ESSENTIAL LIFESTYLE THERAPY &CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:BRANDY
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:LSCW
Authorized Official - Phone:312-767-8651
Mailing Address - Street 1:14132 S MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60827-2232
Mailing Address - Country:US
Mailing Address - Phone:773-885-2773
Mailing Address - Fax:
Practice Address - Street 1:14132 S MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:IL
Practice Address - Zip Code:60827-2232
Practice Address - Country:US
Practice Address - Phone:773-885-2773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty