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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
178.016409ILMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Polina Reyngold, LTD Past
since Feb 27, 2022
Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
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

Other providers in Evanston, IL

All providers in Evanston, IL · Mental Health Counselor in Illinois

Sources for this page

Verify at the official NPI Registry.