Healthcare Provider Details

I. General information

NPI: 1265147870
Provider Name (Legal Business Name): EN ROUTE COUNSELING AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W BELMONT AVE STE 400C
CHICAGO IL
60657-3200
US

IV. Provider business mailing address

1300 W BELMONT AVE STE 400C
CHICAGO IL
60657-3200
US

V. Phone/Fax

Practice location:
  • Phone: 773-922-0304
  • Fax:
Mailing address:
  • Phone: 773-922-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DIAMOND GRAHAM TUCKER
Title or Position: OWNER
Credential: LCPC
Phone: 773-922-0304