Healthcare Provider Details

I. General information

NPI: 1639561673
Provider Name (Legal Business Name): GRT COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 03/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 N WINDSOR DR # 201
ARLINGTON HEIGHTS IL
60004-2745
US

IV. Provider business mailing address

2640 N WINDSOR DR # 201
ARLINGTON HEIGHTS IL
60004-2745
US

V. Phone/Fax

Practice location:
  • Phone: 847-875-5422
  • Fax:
Mailing address:
  • Phone: 847-875-5422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.008755
License Number StateIL

VIII. Authorized Official

Name: MR. GEORGE ROBERT TASEFF
Title or Position: FOUNDER/PRESIDENT
Credential: M.A., LCPC
Phone: 847-875-5422