Ozaz H Abdalla
Individual provider Active NPI Mental Health Counselor · Evanston, IL
NPI 1154077477 · NPPES record last updated Feb 24, 2022
Key facts
- NPI
- 1154077477
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- License
- 178.016409 (IL)
- Practice address
- 622 Davis St Ste 200
Evanston, IL 60201-4491 - Phone
- (773) 294-0176
- NPI assigned
- Feb 24, 2022
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 178.016409 | IL | MD | Mental Health Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Polina Reyngold, LTD | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 178.016409 | IL | Yes |
Addresses
Primary practice location
622 Davis St Ste 200
Evanston, IL 60201-4491
Mailing address
5500 W Leland Ave
Chicago, IL 60630-3513
Phone (224) 303-6341
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All providers in Evanston, IL · Mental Health Counselor in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 24, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.