Healthcare Provider Details

I. General information

NPI: 1063731651
Provider Name (Legal Business Name): JOURNEYS COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2010
Last Update Date: 05/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 EUCLID AVE
ROLLING MEADOWS IL
60008-2083
US

IV. Provider business mailing address

4200 EUCLID AVE
ROLLING MEADOWS IL
60008-2083
US

V. Phone/Fax

Practice location:
  • Phone: 847-833-1930
  • Fax:
Mailing address:
  • Phone: 847-833-1930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180-1244
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149-010194
License Number StateIL

VIII. Authorized Official

Name: ROBERT J GEISS
Title or Position: MEMBER MANAGER
Credential: PHD
Phone: 847-833-8544