Organization
CASA SOLUNA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA CARRILLO-GUERRERO LCPC (FOUNDER/EXECUTIVE DIRECTOR)
(773) 615-5415
Entity
Organization
Contact information
Practice address
1653 W 35TH ST, CHICAGO, IL 60609-1309
(708) 613-7862
Mailing address
1653 W 35TH ST, CHICAGO, IL 60609-1309
(708) 613-7862
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
10/04/2023
Last updated
12/13/2023
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