Provider Demographics
NPI:1205647419
Name:MFBSTUDIO INC
Entity type:Organization
Organization Name:MFBSTUDIO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ LCPC PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:MARY FRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAZAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-688-9171
Mailing Address - Street 1:6055 W 64TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-5307
Mailing Address - Country:US
Mailing Address - Phone:773-710-4428
Mailing Address - Fax:
Practice Address - Street 1:475 W 55TH ST STE 108
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3565
Practice Address - Country:US
Practice Address - Phone:708-688-9171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty