Healthcare Provider Details

I. General information

NPI: 1720462799
Provider Name (Legal Business Name): LIFE SOLUTIONS: INTEGRATIVE HEALING & WELL BEING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2015
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E LINCOLN HWY STE 1
DEKALB IL
60115-3990
US

IV. Provider business mailing address

1500 E. LINCOLN HWY STE 1 1500
DEKALB IL
60115
US

V. Phone/Fax

Practice location:
  • Phone: 779-777-7933
  • Fax: 630-566-3323
Mailing address:
  • Phone: 779-201-8006
  • Fax: 779-256-0204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.006446
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.006446
License Number StateIL

VIII. Authorized Official

Name: DR. MARGO MILANO
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD, LCPC, CFLE, NCC
Phone: 779-201-8006