Healthcare Provider Details

I. General information

NPI: 1801661392
Provider Name (Legal Business Name): GOOD LIFE MENTAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2023
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 WASHINGTON ST APT 1B
EVANSTON IL
60202-2238
US

IV. Provider business mailing address

910 WASHINGTON ST APT 1B
EVANSTON IL
60202-2238
US

V. Phone/Fax

Practice location:
  • Phone: 630-484-0074
  • Fax:
Mailing address:
  • Phone: 630-484-0074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. VANESSA DE LEON
Title or Position: OWNER
Credential: LCPC, BC-DMT
Phone: 630-484-0074