Healthcare Provider Details

I. General information

NPI: 1417797564
Provider Name (Legal Business Name): NEW BEGINNINGS CLINICAL COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2024
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 MAIN ST
OSWEGO IL
60543-9893
US

IV. Provider business mailing address

26104 W MILESTONE DR
PLAINFIELD IL
60585-2342
US

V. Phone/Fax

Practice location:
  • Phone: 847-322-6382
  • Fax:
Mailing address:
  • Phone:
  • 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: JENNIFER BAQUERO
Title or Position: OWNER
Credential: LCPC, CADC
Phone: 847-322-6382