| Holding Space For Psychological Wellness, Llc | |
|
444 N Northwest Hwy Ste 250 Park Ridge IL 60068-3276 | |
| (773) 796-7044 | |
| Not Available |
| Full Name | Holding Space For Psychological Wellness, Llc |
|---|---|
| Speciality | Psychologist |
| Location | 444 N Northwest Hwy Ste 250, Park Ridge, Illinois |
| Authorized Official Name and Position | Patricia M Villarreal (OWNER) |
| Authorized Official Contact | 7737967035 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Holding Space For Psychological Wellness, Llc 444 N Northwest Hwy Ste 250 Park Ridge IL 60068-3276 Ph: (773) 796-7035 | Holding Space For Psychological Wellness, Llc 444 N Northwest Hwy Ste 250 Park Ridge IL 60068-3276 Ph: (773) 796-7044 |
| NPI Number | 1184271231 |
|---|---|
| Provider Enumeration Date | 08/23/2019 |
| Last Update Date | 10/09/2019 |
| Medicare PECOS PAC ID | 2365773090 |
|---|---|
| Medicare Enrollment ID | O20191011000144 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184271231 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Patricia Villarreal |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1598279234 PECOS PAC ID: 1456613082 Enrollment ID: I20180320001427 |
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