Healthcare Provider Details

I. General information

NPI: 1295294700
Provider Name (Legal Business Name): WHOLISTIC CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 MERTON AVE
GLEN ELLYN IL
60137-5203
US

IV. Provider business mailing address

311 MERTON AVE
GLEN ELLYN IL
60137-5203
US

V. Phone/Fax

Practice location:
  • Phone: 630-790-9488
  • Fax: 630-545-3630
Mailing address:
  • Phone: 630-790-9488
  • Fax: 630-545-3630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. JEAN MARIE TSCHAMPA LOPOTKO
Title or Position: OWNER/MENTAL HEALTH COUNSELOR
Credential: LCPC, RPH
Phone: 630-790-9488