Provider Demographics
NPI:1659755700
Name:BETH HENNESSEY, P.C.
Entity Type:Organization
Organization Name:BETH HENNESSEY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNESSEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-304-7148
Mailing Address - Street 1:1243 W GRANVILLE AVE # 2W
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1904
Mailing Address - Country:US
Mailing Address - Phone:773-304-7148
Mailing Address - Fax:
Practice Address - Street 1:3523 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-1137
Practice Address - Country:US
Practice Address - Phone:773-929-6261
Practice Address - Fax:773-929-6762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL108.007468101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty