Healthcare Provider Details

I. General information

NPI: 1568377042
Provider Name (Legal Business Name): THIRD COAST COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 RIDGE AVE APT 406
EVANSTON IL
60201-4174
US

IV. Provider business mailing address

1555 RIDGE AVE APT 406
EVANSTON IL
60201-4174
US

V. Phone/Fax

Practice location:
  • Phone: 847-448-0648
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: JENNA GREIG
Title or Position: FOUNDER AND MENTAL HEALTH COUNSELOR
Credential:
Phone: 847-448-0648