Healthcare Provider Details

I. General information

NPI: 1730863754
Provider Name (Legal Business Name): BLOCK COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 06/12/2023
Certification Date: 06/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6732 NANTUCKET CT
GURNEE IL
60031-4014
US

IV. Provider business mailing address

6732 NANTUCKET CT
GURNEE IL
60031-4014
US

V. Phone/Fax

Practice location:
  • Phone: 224-572-3328
  • Fax:
Mailing address:
  • Phone: 224-572-3328
  • 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: LISA S. BLOCK
Title or Position: COUNSELOR, MENTAL HEALTH
Credential: LCPC
Phone: 847-485-9608