Healthcare Provider Details

I. General information

NPI: 1033811963
Provider Name (Legal Business Name): SIMPLE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CHATHAM RD STE 8115
SPRINGFIELD IL
62704-4188
US

IV. Provider business mailing address

2501 CHATHAM RD STE 8115
SPRINGFIELD IL
62704-4188
US

V. Phone/Fax

Practice location:
  • Phone: 224-201-7333
  • Fax:
Mailing address:
  • Phone: 224-201-7333
  • Fax:

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 Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ISIS MENDOZAGARNICA
Title or Position: CLINICIAN/THERAPIST
Credential: L.C.P.C.
Phone: 315-547-0502