Healthcare Provider Details

I. General information

NPI: 1518105055
Provider Name (Legal Business Name): ENCOURAGING CHANGES COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2009
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13717 S ROUTE 30 SUITE 159
PLAINFIELD IL
60544-5527
US

IV. Provider business mailing address

13717 S ROUTE 30 SUITE 159
PLAINFIELD IL
60544-5527
US

V. Phone/Fax

Practice location:
  • Phone: 815-274-3416
  • Fax: 815-556-8176
Mailing address:
  • Phone: 815-274-3416
  • Fax: 815-556-8176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.006068
License Number StateIL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. AIMEE MICETIC
Title or Position: OWNER
Credential: LCPC
Phone: 815-274-3416