Healthcare Provider Details

I. General information

NPI: 1285005611
Provider Name (Legal Business Name): TAKING CONTROL PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2015
Last Update Date: 10/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S LINCOLNWAY STE F
NORTH AURORA IL
60542-1597
US

IV. Provider business mailing address

106 S LINCOLNWAY STE F
NORTH AURORA IL
60542-1597
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 TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.003228
License Number StateIL

VIII. Authorized Official

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