Basic Information
Provider Information
NPI: 1407276074
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LLAMAS
FirstName: ALMA
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1820 S 25TH AVE
Address2:  
City: BROADVIEW
State: IL
PostalCode: 601552864
CountryCode: US
TelephoneNumber: 7086810073
FaxNumber:  
Practice Location
Address1: 1414 MAIN ST
Address2:  
City: MELROSE PARK
State: IL
PostalCode: 601603902
CountryCode: US
TelephoneNumber: 7086810073
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/23/2014
LastUpdateDate: 12/22/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800XNONE Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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