Individual
MRS. PHYLLIS BARNES BOOTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LMFT, LCPC.
Contact information
Practice address
5550 SO. SOUTH SHORE DRIVE, #1415, CHICAGO, IL 60637
(773) 753-4674
Mailing address
5550 SOUTH SOUTH SHORE DRIVE, #1415, CHICAGO, IL 60637
(773) 753-4674
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
180-000-574
IL
106H00000X
Marriage & Family Therapist
Primary
166-000-152
IL
Other
Enumeration date
01/12/2015
Last updated
01/12/2015
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