Organization
BOULEVARD COUNSELING PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANETTE LEE LCSW, JD (PSYCHOTHERAPIST)
(419) 595-0667
Entity
Organization
Contact information
Practice address
1835 S HAMLIN AVE, CHICAGO, IL 60623-3895
(419) 595-0667
Mailing address
1835 S HAMLIN AVE, CHICAGO, IL 60623-3895
(419) 595-0667
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103T00000X
Psychologist
—
—
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
08/09/2023
Last updated
08/14/2023
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