Healthcare Provider Details

I. General information

NPI: 1366976466
Provider Name (Legal Business Name): GIANNASI MENTAL HEALTH COUNSELORS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 04/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 CURTISS STREET
DOWNERS GROVE IL
60515
US

IV. Provider business mailing address

14808 S HAWTHORN CIRCLE
PLAINFIELD IL
60544
US

V. Phone/Fax

Practice location:
  • Phone: 630-300-8928
  • Fax:
Mailing address:
  • Phone: 630-300-8928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1800008683
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1800008683
License Number StateIL

VIII. Authorized Official

Name: ROBERT N GIANNASI
Title or Position: PRESIDENT
Credential: LCPC
Phone: 847-989-2546