Healthcare Provider Details

I. General information

NPI: 1033632104
Provider Name (Legal Business Name): DEPTH COUNSELING SERVICES P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S MICHIGAN AVE STE 1441
CHICAGO IL
60603-6173
US

IV. Provider business mailing address

122 S MICHIGAN AVE STE 1441
CHICAGO IL
60603-6173
US

V. Phone/Fax

Practice location:
  • Phone: 312-786-4990
  • Fax:
Mailing address:
  • Phone: 312-786-4990
  • Fax:

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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number180008936
License Number StateIL

VIII. Authorized Official

Name: MR. GREGORY RIZZOLO
Title or Position: OWNER
Credential: LCPC
Phone: 312-786-4990