Healthcare Provider Details

I. General information

NPI: 1013828391
Provider Name (Legal Business Name): LIFE EXPERIENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 NAPERVILLE WHEATON RD SUITE 103
NAPERVILLE IL
60563
US

IV. Provider business mailing address

LIFE EXPERIENCE 1555 NAPERVILLE WHEATON RD #103
NAPERVILLE IL
60563
US

V. Phone/Fax

Practice location:
  • Phone: 708-663-2249
  • Fax: 630-364-5898
Mailing address:
  • Phone: 708-663-2249
  • Fax: 630-364-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NICOLO CALOVETO
Title or Position: OWNER/PRESIDENT
Credential: LCPC
Phone: 708-663-2249