Healthcare Provider Details

I. General information

NPI: 1932031200
Provider Name (Legal Business Name): NURTURING WOMANHOOD THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROOSEVELT RD STE E220
GLEN ELLYN IL
60137-5868
US

IV. Provider business mailing address

800 ROOSEVELT RD STE E220
GLEN ELLYN IL
60137-5868
US

V. Phone/Fax

Practice location:
  • Phone: 219-789-5071
  • Fax:
Mailing address:
  • Phone: 219-789-5071
  • 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: AMY RUNGE
Title or Position: OWNER
Credential: LCPC
Phone: 219-789-5071