Provider Demographics
NPI:1679349203
Name:PEACEABLE PRACTICE LLC
Entity Type:Organization
Organization Name:PEACEABLE PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWVER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CLANCY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:312-282-7240
Mailing Address - Street 1:1834 N SAYRE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60707-3836
Mailing Address - Country:US
Mailing Address - Phone:312-282-7240
Mailing Address - Fax:
Practice Address - Street 1:1834 N SAYRE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60707-3836
Practice Address - Country:US
Practice Address - Phone:312-282-7240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty