Healthcare Provider Details

I. General information

NPI: 1720541915
Provider Name (Legal Business Name): HEALING MIND COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2019
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 BANYON CT
NAPERVILLE IL
60540-6344
US

IV. Provider business mailing address

1169 BANYON CT
NAPERVILLE IL
60540-6344
US

V. Phone/Fax

Practice location:
  • Phone: 630-248-6069
  • Fax:
Mailing address:
  • Phone: 630-248-6069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATHERINE A GONZALEZ
Title or Position: COUNSELOR
Credential: LCPC
Phone: 630-248-6069