Healthcare Provider Details

I. General information

NPI: 1710206644
Provider Name (Legal Business Name): LIFECARE COUNSELING, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 N MAIN ST STE 202
GLEN ELLYN IL
60137-5176
US

IV. Provider business mailing address

460 N MAIN ST STE 202
GLEN ELLYN IL
60137-5176
US

V. Phone/Fax

Practice location:
  • Phone: 630-984-4896
  • Fax: 630-545-3630
Mailing address:
  • Phone: 630-984-4896
  • Fax: 630-545-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180006762
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number051.034790
License Number StateIL

VIII. Authorized Official

Name: MRS. HOLLY LYNNE SHRAKE
Title or Position: CLINICAL DIRECTOR
Credential: M.S., L.C.P.C., NCC
Phone: 630-984-4896