Organization
CONVENTIONS PSYCHIATRY & COUNSELING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTA L LANE (PRACTICE MANAGER)
(630) 416-8289
Entity
Organization
Contact information
Practice address
4S 100 ROUTE 59, UNIT 6, NAPERVILLE, IL 60563
(630) 416-8289
Mailing address
2915 DOROTHY DR, AURORA, IL 60504-7520
(630) 898-7133
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
149011145
IL
Other
Enumeration date
03/21/2007
Last updated
05/02/2008
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