Organization
BREATHE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. WINIFRED BRADSHAW CRC/LCPC (DIRECTOR)
(847) 461-8718
Entity
Organization
Contact information
Practice address
15255 S 94TH AVE, ORLAND PARK, IL 60462-3800
(847) 461-8718
(847) 485-5605
Mailing address
329 W 102ND PL, CHICAGO, IL 60628-1916
(847) 461-8718
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
180008522
IL
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
180008522
IL
101YP2500X
Professional Counselor
Primary
180.008522
IL
102L00000X
Psychoanalyst
180008522
IL
106H00000X
Marriage & Family Therapist
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
273R00000X
Psychiatric Hospital Unit
—
—
305R00000X
Preferred Provider Organization
—
—
Other
Enumeration date
09/18/2014
Last updated
04/19/2016
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