Healthcare Provider Details

I. General information

NPI: 1104798180
Provider Name (Legal Business Name): SUNRISE COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4481 ASH GROVE DR STE B
SPRINGFIELD IL
62711-6359
US

IV. Provider business mailing address

4481 ASH GROVE DR STE B
SPRINGFIELD IL
62711-6359
US

V. Phone/Fax

Practice location:
  • Phone: 309-270-5421
  • Fax:
Mailing address:
  • Phone: 309-270-5421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: TOMMY THOMPSON
Title or Position: OWNER
Credential: LCPC
Phone: 217-491-2708