Organization
AMY BAZELON LCPC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY BAZELON LCPC (MEMBER)
(847) 707-5424
Entity
Organization
Contact information
Practice address
839 MOSELEY RD, HIGHLAND PARK, IL 60035-4635
(847) 707-5424
Mailing address
839 MOSELEY RD, HIGHLAND PARK, IL 60035-4635
(847) 432-8968
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
180.010546
IL
Other
Enumeration date
03/13/2018
Last updated
10/28/2021
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