Eustress Therapy and Wellness

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

180-003124 Issued in IL

Legal business name

EUSTRESS THERAPY AND WELLNESS

Practice address

9510 S Constance Ave
Suite C-6
Chicago, IL 60617-4700

Phone

(872) 221-0041

Fax

(866) 683-7047

NPI assigned

Apr 1, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mustafa Moyenda, LCPC, CAADC

Title

Coo

Phone

(872) 221-0041

Specialties & licenses 3

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1364774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376870400000",
    "number": "1083957757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4655 S LAKE PARK AVE",
            "address_2": "# 024",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606534532",
            "telephone_number": "872-221-0041",
            "fax_number": "866-683-7047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9510 S CONSTANCE AVE",
            "address_2": "SUITE C-6",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606174700",
            "telephone_number": "872-221-0041",
            "fax_number": "866-683-7047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EUSTRESS THERAPY AND WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-01",
        "last_updated": "2013-08-19",
        "status": "A",
        "authorized_official_last_name": "MOYENDA",
        "authorized_official_first_name": "MUSTAFA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "872-221-0041",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCPC, CAADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "14823",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "IL",
            "license": "180-003124",
            "primary": true
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": "IL",
            "license": "227013113",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Chicago, IL
• Providers in Chicago, IL by specialty
• Professional Counselor in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.