Organization
OUR HOUSE THERAPY COLLECTIVE A HEALING COMMUNITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE R MCCONVILLE PHD (TREASURER)
(919) 360-5177
Entity
Organization
Contact information
Practice address
2858 W DIVERSEY AVE, CHICAGO, IL 60647-1871
(708) 941-1761
Mailing address
2858 W DIVERSEY AVE, CHICAGO, IL 60647-1871
(708) 941-1761
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
—
103TC0700X
Clinical Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Enumeration date
07/20/2021
Last updated
05/24/2023
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