Healthcare Provider Details

I. General information

NPI: 1194661884
Provider Name (Legal Business Name): NURTURED ROOTS COUNSELING AND CONSULTING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4327 W IRVING PARK RD STE 2A
CHICAGO IL
60641-2826
US

IV. Provider business mailing address

3425 N KOSTNER AVE
CHICAGO IL
60641-3806
US

V. Phone/Fax

Practice location:
  • Phone: 920-988-7549
  • Fax:
Mailing address:
  • Phone: 920-988-7549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. AMANDA JONES-FISCHER
Title or Position: THERAPIST/OWNER
Credential: LCSW
Phone: 920-988-7549