Healthcare Provider Details

I. General information

NPI: 1356134878
Provider Name (Legal Business Name): REPURPOSED COUNSELING & COACHING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 SPRING RD STE 106
OAK BROOK IL
60523-3603
US

IV. Provider business mailing address

933 S MICHIGAN AVE
VILLA PARK IL
60181-3140
US

V. Phone/Fax

Practice location:
  • Phone: 708-528-3766
  • Fax:
Mailing address:
  • Phone: 708-528-3766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: AMY R S BAKER
Title or Position: OWNER
Credential: LCPC
Phone: 708-528-3766