Organization
INTENTIONAL LIVING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE DUDA (OWNER)
(312) 566-8417
Entity
Organization
Contact information
Practice address
1041 N WESTERN AVE FL 1, CHICAGO, IL 60622-3571
(312) 566-8417
Mailing address
1841 N MONTICELLO AVE APT 1E, CHICAGO, IL 60647-4741
(630) 392-8628
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
04/06/2020
Last updated
04/06/2020
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