Healthcare Provider Details

I. General information

NPI: 1245186162
Provider Name (Legal Business Name): DAYRISE WELLNESS CLINICIANS OF ILLINOIS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 WATERS EDGE STE 100
LOMBARD IL
60148-7002
US

IV. Provider business mailing address

500 WATERS EDGE STE 100
LOMBARD IL
60148-7002
US

V. Phone/Fax

Practice location:
  • Phone: 331-425-8625
  • Fax: 331-333-1370
Mailing address:
  • Phone: 331-425-8625
  • Fax: 331-333-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY BESEDA
Title or Position: CFO
Credential:
Phone: 630-606-6122