Healthcare Provider Details

I. General information

NPI: 1124988506
Provider Name (Legal Business Name): POSITIVE IMPACT SOLUTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4749 LINCOLN MALL DR STE 100
MATTESON IL
60443-3806
US

IV. Provider business mailing address

4749 LINCOLN MALL DR STE 100
MATTESON IL
60443-3806
US

V. Phone/Fax

Practice location:
  • Phone: 312-857-6175
  • Fax: 773-901-3764
Mailing address:
  • Phone: 312-857-6175
  • Fax: 773-901-3764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AARON WHITE JOHNSON
Title or Position: CEO
Credential:
Phone: 630-926-9386