Healthcare Provider Details

I. General information

NPI: 1902638141
Provider Name (Legal Business Name): PEACE RENEWED COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E ARMY TRAIL RD STE 207
BLOOMINGDALE IL
60108-2103
US

IV. Provider business mailing address

201 E ARMY TRAIL RD STE 207
BLOOMINGDALE IL
60108-2103
US

V. Phone/Fax

Practice location:
  • Phone: 630-358-9040
  • Fax: 630-982-3138
Mailing address:
  • Phone: 630-358-9040
  • Fax: 630-982-3138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J WALTERS
Title or Position: OWNER/THERAPIST
Credential: MA, LCPC, CCATP
Phone: 630-358-9040