Organization
INTEGRATIVE PRIMARY CARE AND MENTAL HEALTH CLINIC, LLC
Active
Organization
INTEGRATIVE PRIMARY CARE AND MENTAL HEALTH CLINIC, LLC
Active
Other names
Integrative Primary Care and Mental Health Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE CHAN DNP, FNP-BC, PMHNP-B (MANAGER)
(312) 975-8268
Entity
Organization
Contact information
Practice address
3201 S WALLACE ST, CHICAGO, IL 60616-3501
(312) 975-8268
Mailing address
3201 S WALLACE ST, CHICAGO, IL 60616-3501
(312) 975-8268
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154187433
GROUP NPI
IL
01
—
1497299689
INDIVIDUAL NPI
IL
Enumeration date
02/26/2024
Last updated
09/06/2024
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