Organization
OLIPHANT THERAPY AND WELLNESS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EBONY OLIPHANT (OWNER)
(224) 269-0286
Entity
Organization
Contact information
Practice address
1130 S CANAL ST # 1249, CHICAGO, IL 60607-4907
(224) 269-0286
Mailing address
2501 CHATHAM RD STE R, SPRINGFIELD, IL 62704-4188
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
04/18/2022
Last updated
04/18/2022
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