Healthcare Provider Details

I. General information

NPI: 1104476522
Provider Name (Legal Business Name): INFINITY CENTER FOR PERSONAL GROWTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2019
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 MERCHANT DR
ALGONQUIN IL
60102-5917
US

IV. Provider business mailing address

1489 MERCHANT DR
ALGONQUIN IL
60102-5917
US

V. Phone/Fax

Practice location:
  • Phone: 815-444-9700
  • Fax: 224-304-4664
Mailing address:
  • Phone: 815-444-9700
  • Fax: 224-304-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LAURA A PICCOLO
Title or Position: CEO
Credential: MA, LCPC
Phone: 815-444-9700