Healthcare Provider Details

I. General information

NPI: 1952199374
Provider Name (Legal Business Name): DEFINING MOMENTS COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2025
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2155 CARPENTER AVE
PLAINFIELD IL
60586-5943
US

IV. Provider business mailing address

2155 CARPENTER AVE
PLAINFIELD IL
60586-5943
US

V. Phone/Fax

Practice location:
  • Phone: 816-909-6586
  • Fax:
Mailing address:
  • Phone: 815-909-6586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. DEANNE MARIE WOLTER
Title or Position: CLINICAL MENTAL HEALTH COUNSELOR
Credential: EDD, LCPC
Phone: 815-909-6586