Healthcare Provider Details

I. General information

NPI: 1972268464
Provider Name (Legal Business Name): VERDANT OAK COUNSELING SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 N PROSPECT AVE # 1047
CHAMPAIGN IL
61822-1235
US

IV. Provider business mailing address

2005 N PROSPECT AVE # 1047
CHAMPAIGN IL
61822-1235
US

V. Phone/Fax

Practice location:
  • Phone: 815-200-6874
  • Fax:
Mailing address:
  • Phone: 815-200-6874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW JEFFREY RITCHIE
Title or Position: THERAPIST/OWNER
Credential: LCPC
Phone: 815-200-6874