Healthcare Provider Details

I. General information

NPI: 1427755891
Provider Name (Legal Business Name): PEACEFUL HEALING COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15010 S RAVINIA AVE STE 12
ORLAND PARK IL
60462-5353
US

IV. Provider business mailing address

15010 S RAVINIA AVE STE 12
ORLAND PARK IL
60462-5353
US

V. Phone/Fax

Practice location:
  • Phone: 708-971-0470
  • Fax:
Mailing address:
  • Phone: 708-971-0470
  • Fax: 708-590-6573

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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNIFER CHICOINE
Title or Position: OWNER/SOLE MEMBER
Credential: M.A., LCPC, CCTP
Phone: 708-971-0470