Healthcare Provider Details

I. General information

NPI: 1558631275
Provider Name (Legal Business Name): LOMBARD COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 N MAIN ST STE 3
LOMBARD IL
60148-2351
US

IV. Provider business mailing address

9 N MAIN ST STE 3
LOMBARD IL
60148-2351
US

V. Phone/Fax

Practice location:
  • Phone: 630-202-8141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180006999
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149012096
License Number StateIL

VIII. Authorized Official

Name: ANNE LINDGREN
Title or Position: LCPC
Credential:
Phone: 630-202-8141