Healthcare Provider Details

I. General information

NPI: 1437621422
Provider Name (Legal Business Name): HEALTH AND HEALING THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/01/2019
Last Update Date: 01/19/2020
Certification Date: 01/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W. BARTLETT RD STE 14C
BARTLETT IL
60103-4454
US

IV. Provider business mailing address

850 W BARTLETT RD STE 14C
BARTLETT IL
60103-4454
US

V. Phone/Fax

Practice location:
  • Phone: 630-864-7267
  • Fax: 630-596-0743
Mailing address:
  • Phone: 630-864-7267
  • Fax: 630-596-0743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: COLLEEN KONCILJA
Title or Position: PRACTICE DIRECTOR & OWNER
Credential: LCSW CADC ICGC-II
Phone: 630-864-7267