Healthcare Provider Details

I. General information

NPI: 1609794536
Provider Name (Legal Business Name): ILLINOIS COUNSELING CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1721 MOON LAKE BLVD STE 420
HOFFMAN ESTATES IL
60169-1073
US

IV. Provider business mailing address

1030 SE 14TH DR
DEERFIELD BEACH FL
33441-7231
US

V. Phone/Fax

Practice location:
  • Phone: 413-231-2523
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN CROALL
Title or Position: MEMBER
Credential:
Phone: 413-231-2523