Healthcare Provider Details

I. General information

NPI: 1134393978
Provider Name (Legal Business Name): NORTHWEST COUNSELING LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1491 S BELL SCHOOL RD
ROCKFORD IL
61108-1407
US

IV. Provider business mailing address

1491 S BELL SCHOOL RD
ROCKFORD IL
61108-1407
US

V. Phone/Fax

Practice location:
  • Phone: 815-227-9402
  • Fax: 815-227-9412
Mailing address:
  • Phone: 815-227-9402
  • Fax: 815-227-9412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateIL

VIII. Authorized Official

Name: MS. LYNN E CADMUS
Title or Position: PARTNER
Credential: LCSW
Phone: 815-227-9402