Healthcare Provider Details

I. General information

NPI: 1144789439
Provider Name (Legal Business Name): HEALED AND WHOLE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 03/01/2022
Certification Date: 09/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 W JACKSON BLVD STE 1605
CHICAGO IL
60604-3762
US

IV. Provider business mailing address

53 W JACKSON BLVD STE 1605
CHICAGO IL
60604-3762
US

V. Phone/Fax

Practice location:
  • Phone: 312-725-9980
  • Fax:
Mailing address:
  • Phone: 312-725-9980
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LAUREN MCBRIDE
Title or Position: PSYCHOTHERAPIST
Credential: LCPC
Phone: 708-264-4627