Healthcare Provider Details

I. General information

NPI: 1265159115
Provider Name (Legal Business Name): WUNDERLICH COUNSELING & CONSULTING LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 IL ROUTE 83 STE 204
LONG GROVE IL
60047-8034
US

IV. Provider business mailing address

318 W HALF DAY ROAD PMB 284
BUFFALO GROVE IL
60089
US

V. Phone/Fax

Practice location:
  • Phone: 847-380-4806
  • Fax:
Mailing address:
  • Phone: 847-380-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND C WUNDERLICH JR.
Title or Position: OWNER & PRESIDENT
Credential: LCPC
Phone: 847-380-4806