Healthcare Provider Details

I. General information

NPI: 1982301446
Provider Name (Legal Business Name): CBB COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 ELLINWOOD AVE STE 106
DES PLAINES IL
60016-4535
US

IV. Provider business mailing address

2109 GLENVIEW AVE
PARK RIDGE IL
60068-1719
US

V. Phone/Fax

Practice location:
  • Phone: 310-403-3825
  • Fax:
Mailing address:
  • Phone: 310-403-3825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. COURTNEY BLUM BOWLES
Title or Position: THERAPIST/OWNER
Credential: LCSW
Phone: 310-403-3825