Healthcare Provider Details

I. General information

NPI: 1689391500
Provider Name (Legal Business Name): RECLAIMING HOPE WELLNESS CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9506 PARK LN
DES PLAINES IL
60016-3904
US

IV. Provider business mailing address

9506 PARK LN
DES PLAINES IL
60016-3904
US

V. Phone/Fax

Practice location:
  • Phone: 847-834-4474
  • Fax:
Mailing address:
  • Phone: 847-834-4474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: LISA MANDL
Title or Position: PRESIDENT
Credential: LCPC
Phone: 847-834-4474