Healthcare Provider Details

I. General information

NPI: 1437563798
Provider Name (Legal Business Name): INNOVATIVE COUNSELING PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 LAKE ST STE 806
OAK PARK IL
60301-1417
US

IV. Provider business mailing address

715 LAKE ST STE 800
OAK PARK IL
60301-1417
US

V. Phone/Fax

Practice location:
  • Phone: 312-343-7400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number248001003
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number248001003
License Number StateIL

VIII. Authorized Official

Name: JENNIFER FROEMEL
Title or Position: CEO/OWNER
Credential: LCPC
Phone: 312-343-7400