Healthcare Provider Details

I. General information

NPI: 1124634852
Provider Name (Legal Business Name): PROSPER COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 09/17/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 W JUNIOR TER APT 303
CHICAGO IL
60613-1657
US

IV. Provider business mailing address

808 W JUNIOR TER APT 303
CHICAGO IL
60613-1657
US

V. Phone/Fax

Practice location:
  • Phone: 516-729-8863
  • Fax:
Mailing address:
  • Phone: 516-729-8863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ERIC WILLIAM HERSKOWITZ
Title or Position: OWNER
Credential: LCPC
Phone: 516-729-8863