Healthcare Provider Details

I. General information

NPI: 1578176632
Provider Name (Legal Business Name): OHANA COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 N DIVISION ST STE 111
MORRIS IL
60450-1182
US

IV. Provider business mailing address

7605 OAKSHIRE CT
PLAINFIELD IL
60586-4141
US

V. Phone/Fax

Practice location:
  • Phone: 815-242-0277
  • Fax:
Mailing address:
  • Phone:
  • 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: MARLY LIO
Title or Position: LCPC
Credential:
Phone: 773-386-0878