Healthcare Provider Details

I. General information

NPI: 1215569702
Provider Name (Legal Business Name): ILLINOIS SLEEP COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 JEFFERSON AVE
GLENCOE IL
60022-1824
US

IV. Provider business mailing address

342 JEFFERSON AVE
GLENCOE IL
60022-1824
US

V. Phone/Fax

Practice location:
  • Phone: 401-441-2451
  • Fax:
Mailing address:
  • Phone: 401-441-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number StateNULL

VIII. Authorized Official

Name: CELSO TEIXEIRA
Title or Position: FOUNDER
Credential: LCPC
Phone: 224-707-0720