Healthcare Provider Details

I. General information

NPI: 1053901322
Provider Name (Legal Business Name): ENCOMPASS COUNSELING & THERAPY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 CARRIAGEWAY DR APT 203C
ROLLING MEADOWS IL
60008-3963
US

IV. Provider business mailing address

5500 CARRIAGEWAY DR APT 203C
ROLLING MEADOWS IL
60008-3963
US

V. Phone/Fax

Practice location:
  • Phone: 847-454-3051
  • Fax: 847-454-3052
Mailing address:
  • Phone: 847-454-3051
  • Fax: 847-454-3052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE JAEGER
Title or Position: LCSW
Credential: LCSW
Phone: 815-757-2743