Healthcare Provider Details

I. General information

NPI: 1134750763
Provider Name (Legal Business Name): LIFE COMPASS BEHAVIORAL HEALTH AND WELLNESS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2020
Last Update Date: 02/02/2020
Certification Date: 02/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 E TRACY ST
DIAMOND IL
60416-9409
US

IV. Provider business mailing address

2095 E TRACY ST
DIAMOND IL
60416-9409
US

V. Phone/Fax

Practice location:
  • Phone: 815-823-6972
  • Fax:
Mailing address:
  • Phone: 815-823-6972
  • Fax:

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: HILARY E. KOHS
Title or Position: PRESIDENT/TREASURER
Credential: LCSW, ACSW
Phone: 815-823-6972