Healthcare Provider Details

I. General information

NPI: 1184468621
Provider Name (Legal Business Name): JAB COUNSELING AND CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20542 PARTHENON WAY
OLYMPIA FIELDS IL
60461-1333
US

IV. Provider business mailing address

20542 PARTHENON WAY
OLYMPIA FIELDS IL
60461-1333
US

V. Phone/Fax

Practice location:
  • Phone: 708-359-6589
  • Fax:
Mailing address:
  • Phone: 708-359-6589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BROWN
Title or Position: OWNER
Credential: LCSW
Phone: 708-359-6589