Provider Demographics
NPI:1790293249
Name:SA INTEGRATIVE HEALTH LLC
Entity Type:Organization
Organization Name:SA INTEGRATIVE HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SAULENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTANAVICIENE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-590-9533
Mailing Address - Street 1:12727 S 82ND CT
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-2018
Mailing Address - Country:US
Mailing Address - Phone:708-590-9533
Mailing Address - Fax:
Practice Address - Street 1:12727 S 82ND CT
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-2018
Practice Address - Country:US
Practice Address - Phone:708-590-9533
Practice Address - Fax:708-590-9533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010389101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty