Healthcare Provider Details

I. General information

NPI: 1245974716
Provider Name (Legal Business Name): ENLIGHTENING JOURNEY CLINICAL THERAPY SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 01/15/2026
Certification Date: 01/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7443 WASHINGTON ST
FOREST PARK IL
60130-1549
US

IV. Provider business mailing address

7443 WASHINGTON ST 301
FOREST PARK IL
60130
US

V. Phone/Fax

Practice location:
  • Phone: 773-217-9868
  • 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
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MARIA CRUZ
Title or Position: OWNER
Credential: LCSW
Phone: 773-217-9868