Healthcare Provider Details

I. General information

NPI: 1851923759
Provider Name (Legal Business Name): PROFESSIONAL FAMILY SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2020
Last Update Date: 04/05/2025
Certification Date: 04/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N RIVERSIDE DR STE 207
GURNEE IL
60031-5918
US

IV. Provider business mailing address

1283 EDGEWOOD RD
LAKE FOREST IL
60045-1310
US

V. Phone/Fax

Practice location:
  • Phone: 847-508-3130
  • Fax:
Mailing address:
  • Phone: 847-234-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. BRENDA MARWEDE
Title or Position: OWNER
Credential: LCPC
Phone: 847-508-3130