Healthcare Provider Details

I. General information

NPI: 1336611102
Provider Name (Legal Business Name): WELL LIFE COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1251 N PLUM GROVE RD STE 120K
SCHAUMBURG IL
60173-5603
US

IV. Provider business mailing address

1221 CAMBIA DR APT 1117
SCHAUMBURG IL
60193-4613
US

V. Phone/Fax

Practice location:
  • Phone: 312-593-0394
  • Fax:
Mailing address:
  • Phone: 847-285-1036
  • Fax: 847-285-1597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. JAIME ANN WILLIAMSON
Title or Position: LCSW/FOUNDER
Credential: LCSW
Phone: 312-593-0394