Organization
NIA SERVICES NFO
Active
Other names
Bakahia Madison PsyB
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BAKAHIA MADISON PSY.D. (VICE PRESIDENT)
(773) 807-1195
Entity
Organization
Contact information
Practice address
400 W 76TH ST STE 324, CHICAGO, IL 60620-1640
(773) 666-2642
Mailing address
11136 S SANGAMON ST, CHICAGO, IL 60643-4614
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
Other
Enumeration date
11/14/2018
Last updated
11/14/2018
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