MEDICARE: SAFE HARBOR COUNSELING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	149-008976	IL

General Provider Information

NPI Number	:	1598992430
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFE HARBOR COUNSELING

Provider Business Mailing Address
First Line	:	612 MARIE AVE
Second Line	:
City	:	YORKVILLE
State	:	IL
Zip	:	60560-1211
Country	:	US
Telephone Number	:	630-272-4959
Fax Number	:

Provider Business Practice Location Address
First Line	:	76 S MAIN ST STE A
Second Line	:
City	:	SUGAR GROVE
State	:	IL
Zip	:	60554-5023
Country	:	US
Telephone Number	:	630-272-4959
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. BETH L PLACHETKA
Credential	:	LCSW
Telephone Number	:	630-272-4959

Provider Enumeration Date	:	06/18/2009
Last Update Date	:	06/15/2010

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Directions to “SAFE HARBOR COUNSELING ” Practice Location

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