Healthcare Provider Details

I. General information

NPI: 1194306605
Provider Name (Legal Business Name): TRUST WITHOUT BORDERS COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2021
Last Update Date: 04/16/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W MONROE ST # 302B
BLOOMINGTON IL
61701-3997
US

IV. Provider business mailing address

200 W MONROE ST # 302B
BLOOMINGTON IL
61701-3997
US

V. Phone/Fax

Practice location:
  • Phone: 309-304-3041
  • Fax:
Mailing address:
  • Phone: 309-304-3041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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 Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE MANN
Title or Position: OWNER
Credential:
Phone: 309-304-3041