Healthcare Provider Details

I. General information

NPI: 1104399682
Provider Name (Legal Business Name): TAKING CONTROL PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 SOUTH LINCOLNWAY SUITE A
NORTH AURORA IL
60542
US

IV. Provider business mailing address

106 SOUTH LINCOLNWAY SUITE A
NORTH AURORA IL
60542
US

V. Phone/Fax

Practice location:
  • Phone: 630-801-1669
  • Fax: 630-801-1675
Mailing address:
  • Phone: 630-801-1669
  • Fax: 630-801-1675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: JAMES JORGENSON
Title or Position: EXECUTIVE DIRECTOR
Credential: ED.D., LCPC
Phone: 630-801-1669