Organization
MICHELLE A COSTELLO LCSW, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE ALYSE COSTELLO LCSW (REGISTERED AGENT)
(312) 593-3553
Entity
Organization
Contact information
Practice address
5215 N RAVENSWOOD AVE STE 214, CHICAGO, IL 60640-1670
(312) 476-9722
Mailing address
615 HINMAN AVE APT 3D, EVANSTON, IL 60202-3047
(312) 593-3553
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
10/20/2021
Last updated
10/22/2021
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