Individual
JESSICA SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
EVOLVE THERAPEUTIC SERVICES CENTER, 304 W. MONDAMIN ST. #104, MINOOKA, IL 60447
(815) 274-7308
Mailing address
219 GRANDE DR, MINOOKA, IL 60447-9554
(815) 409-2320
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003
BCBC
—
Enumeration date
12/23/2022
Last updated
12/23/2022
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