Healthcare Provider Details

I. General information

NPI: 1417844697
Provider Name (Legal Business Name): VULTURE SPIRIT HEALING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 WESTSHIRE DR
JOLIET IL
60435-3870
US

IV. Provider business mailing address

1022 WESTSHIRE DR
JOLIET IL
60435-3870
US

V. Phone/Fax

Practice location:
  • Phone: 815-531-9825
  • Fax:
Mailing address:
  • Phone: 815-531-9825
  • 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: KELSEY ANDERSON
Title or Position: MANAGER
Credential: LCSW
Phone: 815-531-9825