Healthcare Provider Details

I. General information

NPI: 1366985145
Provider Name (Legal Business Name): TAKING CONTROL PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date: 11/30/2021
Reactivation Date: 12/22/2021

III. Provider practice location address

106F S LINCOLNWAY
NORTH AURORA IL
60542-1597
US

IV. Provider business mailing address

106F S LINCOLNWAY
NORTH AURORA IL
60542-1597
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number180.003228
License Number StateIL

VIII. Authorized Official

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