Organization
CATHARTIC SPACE LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN JACOBSEN LCPC (OWNER)
(773) 633-9075
Entity
Organization
Contact information
Practice address
3166 N LINCOLN AVE, SUITE 207, CHICAGO, IL 60657-3133
(773) 633-9075
Mailing address
3166 N LINCOLN AVE, SUITE 207, CHICAGO, IL 60657-3133
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
180008355
IL
Other
Enumeration date
01/26/2015
Last updated
01/26/2015
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