Healthcare Provider Details

I. General information

NPI: 1194730788
Provider Name (Legal Business Name): CONNECTIONS COUNSELING & CONSULTING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 CRYSTAL POINT DR STE 3
CRYSTAL LAKE IL
60014-1400
US

IV. Provider business mailing address

610 CRYSTAL POINT DR STE 3
CRYSTAL LAKE IL
60014-1400
US

V. Phone/Fax

Practice location:
  • Phone: 815-477-2270
  • Fax: 815-477-2287
Mailing address:
  • Phone: 815-477-2270
  • Fax: 815-477-2287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH S. CANEVELLO
Title or Position: CLINIC DIRECTOR
Credential: LCSW
Phone: 815-477-2270