Individual
TOLLY BASEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCPC
Contact information
Practice address
2525 W PETERSON AVE, CHICAGO, IL 60659-4108
(773) 765-0618
Mailing address
2525 W PETERSON AVE, CHICAGO, IL 60659-4108
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
180008761
IL
Other
Enumeration date
10/03/2014
Last updated
10/03/2014
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