Organization
IMOLE PSYCHOLOGICAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATIFAT CABIROU PHD (OWNER, PSYCHOLOGIST)
(312) 953-4924
Entity
Organization
Contact information
Practice address
2622 W CERMAK RD APT 1, CHICAGO, IL 60608-6172
(312) 953-4924
Mailing address
1130 S CANAL ST # 1733, CHICAGO, IL 60607-4907
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
06/16/2023
Last updated
06/16/2023
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