Healthcare Provider Details

I. General information

NPI: 1619303666
Provider Name (Legal Business Name): EXISTENTIAL COUNSELOR SOCIET LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2013
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W DIVISION ST
MANTENO IL
60950-1065
US

IV. Provider business mailing address

19506 S HUNTER TRL
MOKENA IL
60448-8841
US

V. Phone/Fax

Practice location:
  • Phone: 708-223-2698
  • Fax:
Mailing address:
  • Phone: 708-250-0520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. BIPIN SHARMA
Title or Position: DIRECTOR/FOUNDER
Credential: PH.D., L.C.P.C.
Phone: 708-250-0520