Provider Demographics
NPI:1497066898
Name:LIFE PATH GUIDANCE, INC.
Entity Type:Organization
Organization Name:LIFE PATH GUIDANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SELBY
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:312-630-9663
Mailing Address - Street 1:8 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3357
Mailing Address - Country:US
Mailing Address - Phone:312-630-9663
Mailing Address - Fax:773-538-5321
Practice Address - Street 1:8 S MICHIGAN AVE
Practice Address - Street 2:SUITE 1500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-3357
Practice Address - Country:US
Practice Address - Phone:312-630-9663
Practice Address - Fax:773-538-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180004609101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty