Healthcare Provider Details

I. General information

NPI: 1093423147
Provider Name (Legal Business Name): ESCUCHAME COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2022
Last Update Date: 11/08/2022
Certification Date: 11/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5N233 BLUFF DR S
ST CHARLES IL
60175-5189
US

IV. Provider business mailing address

5N233 BLUFF DR S
ST CHARLES IL
60175-5189
US

V. Phone/Fax

Practice location:
  • Phone: 708-257-9594
  • Fax:
Mailing address:
  • Phone: 708-257-9594
  • Fax:

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: ELIZABETH BAKULA
Title or Position: LCSW- MANAGER
Credential: LCSW
Phone: 708-257-9594