Healthcare Provider Details

I. General information

NPI: 1336535764
Provider Name (Legal Business Name): NORTHWEST SUBURBAN COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 04/05/2020
Certification Date: 04/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E NORTHWEST HWY UNIT 4
ARLINGTON HEIGHTS IL
60004-6944
US

IV. Provider business mailing address

1800 E NORTHWEST HWY UNIT 4
ARLINGTON HEIGHTS IL
60004-6944
US

V. Phone/Fax

Practice location:
  • Phone: 800-922-0976
  • Fax:
Mailing address:
  • Phone: 800-922-0976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: WHITNEY GIPSON
Title or Position: OWNER
Credential: MSW, LMFT
Phone: 847-322-0756