Healthcare Provider Details
I. General information
NPI: 1871150177
Provider Name (Legal Business Name): LLANES COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/22/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
2901A CENTRAL ST. SUITE 6
EVANSTON IL
60201
US
IV. Provider business mailing address
2300 COLFAX ST
EVANSTON IL
60201-2102
US
V. Phone/Fax
- Phone: 312-927-1191
- Fax: 866-284-8499
- Phone: 312-927-1191
- Fax: 866-284-8499
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
MEGHAN
CHRISTINE
LLANES
Title or Position: OWNER/MANAGER
Credential: LCSW
Phone: 312-927-1191