Healthcare Provider Details

I. General information

NPI: 1710717830
Provider Name (Legal Business Name): CREATING PATHWAYS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 08/05/2024
Certification Date: 08/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 CARRIAGE HOUSE LN
ORLAND PARK IL
60467-1286
US

IV. Provider business mailing address

86 CARRIAGE HOUSE LN
ORLAND PARK IL
60467-1286
US

V. Phone/Fax

Practice location:
  • Phone: 773-505-4836
  • Fax:
Mailing address:
  • Phone: 773-505-4836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMANDA L SAWILCHIK
Title or Position: OWNER
Credential: LCPC
Phone: 773-505-4836