Provider Demographics
NPI:1417739046
Name:HABTAMU, TATEK (QMHP)
Entity Type:Individual
Prefix:
First Name:TATEK
Middle Name:
Last Name:HABTAMU
Suffix:
Gender:M
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2046 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2241
Mailing Address - Country:US
Mailing Address - Phone:773-739-9079
Mailing Address - Fax:
Practice Address - Street 1:2046 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2241
Practice Address - Country:US
Practice Address - Phone:773-739-9079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health