Healthcare Provider Details

I. General information

NPI: 1205695418
Provider Name (Legal Business Name): CAUSEWAY COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S PERRYVILLE RD
ROCKFORD IL
61108-2522
US

IV. Provider business mailing address

6416 PALO VERDE DR
ROCKFORD IL
61114-8174
US

V. Phone/Fax

Practice location:
  • Phone: 815-315-2364
  • Fax:
Mailing address:
  • Phone: 815-315-2364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. CRYSTAL LAWSON
Title or Position: OWNER/MANAGER
Credential: LCSW
Phone: 815-315-2364