Organization
AGAVE STUDIO FOR PSYCHOTHERAPY AND SPIRITUAL DIRECTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JANEIL IRENE RUIZ PSY.D. (EXECUTIVE DIRECTOR AND FOUNDER)
(773) 627-2112
Entity
Organization
Contact information
Practice address
2950 W CHICAGO AVE, #302, CHICAGO, IL 60622-4375
(773) 627-2112
Mailing address
1333 N ARTESIAN AVE # 2, CHICAGO, IL 60622-2935
(773) 627-2112
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
071.008116
IL
Other
Enumeration date
07/02/2012
Last updated
07/02/2012
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