Healthcare Provider Details

I. General information

NPI: 1477418747
Provider Name (Legal Business Name): THE CENTER FOR COURAGEOUS LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 W VIRGINIA ST
CRYSTAL LAKE IL
60014-5756
US

IV. Provider business mailing address

377 W VIRGINIA ST
CRYSTAL LAKE IL
60014-5756
US

V. Phone/Fax

Practice location:
  • Phone: 815-707-4806
  • Fax: 815-977-8715
Mailing address:
  • Phone: 847-809-8494
  • Fax: 815-977-8715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KATIE MARIE KROENING
Title or Position: CEO-OWNER
Credential: LCSW; CADC
Phone: 815-707-4806