Organization
DR. LARA BEANBLOSSOM, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LARA BEANBLOSSOM PSY.D. (LICENSED CLINICAL PSYCHOLOGIST)
(312) 385-9777
Entity
Organization
Contact information
Practice address
30 N MICHIGAN AVE, SUITE 1004, CHICAGO, IL 60602-3402
(312) 385-9777
Mailing address
30 N MICHIGAN AVE, SUITE 1004, CHICAGO, IL 60602-3402
(312) 385-9777
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.006369
IL
Other
Enumeration date
09/06/2011
Last updated
07/13/2015
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