Healthcare Provider Details

I. General information

NPI: 1154234474
Provider Name (Legal Business Name): ICONIC COUNSELING SERVICES, PPLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7244 W BENTON DR
FRANKFORT IL
60423-9303
US

IV. Provider business mailing address

7244 W BENTON DR
FRANKFORT IL
60423-9303
US

V. Phone/Fax

Practice location:
  • Phone: 815-272-7864
  • Fax:
Mailing address:
  • Phone: 815-272-7864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. SIMON NJANG MBI
Title or Position: CEO/PRESIDENT
Credential: LSW, CADC
Phone: 815-272-7864