Healthcare Provider Details

I. General information

NPI: 1720479793
Provider Name (Legal Business Name): NEW PRAIRIE COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 W BUTTERFIELD RD STE 245
ELMHURST IL
60126-5097
US

IV. Provider business mailing address

360 W BUTTERFIELD RD STE 245
ELMHURST IL
60126-5097
US

V. Phone/Fax

Practice location:
  • Phone: 630-478-0488
  • Fax: 773-634-8118
Mailing address:
  • Phone: 630-492-0404
  • Fax: 773-634-8118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM YOUNG
Title or Position: OWNER
Credential:
Phone: 630-492-0404