Healthcare Provider Details

I. General information

NPI: 1093544520
Provider Name (Legal Business Name): HEALING HORIZONS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5113 S HARPER AVE STE 2C
CHICAGO IL
60615-4119
US

IV. Provider business mailing address

5113 S HARPER AVE STE 2C
CHICAGO IL
60615-4119
US

V. Phone/Fax

Practice location:
  • Phone: 773-999-9581
  • Fax:
Mailing address:
  • Phone: 773-999-9581
  • 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 Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL ISRAEL VILLASENOR
Title or Position: OWNER
Credential: LCSW
Phone: 773-999-9581