Provider Demographics
NPI:1932791571
Name:RESERVOIR RESOURCES PLLC
Entity Type:Organization
Organization Name:RESERVOIR RESOURCES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ESHLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:872-201-1290
Mailing Address - Street 1:2650 W MONTROSE AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1674
Mailing Address - Country:US
Mailing Address - Phone:872-201-1290
Mailing Address - Fax:
Practice Address - Street 1:2650 W MONTROSE AVE STE 207
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-1674
Practice Address - Country:US
Practice Address - Phone:708-431-1504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-04
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1255416046OtherNPI