Healthcare Provider Details

I. General information

NPI: 1902402373
Provider Name (Legal Business Name): NEW LIFE OPTIONS COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S PARK ST STE 3
STREATOR IL
61364-4448
US

IV. Provider business mailing address

205 S PARK ST STE 3
STREATOR IL
61364-4448
US

V. Phone/Fax

Practice location:
  • Phone: 815-672-1802
  • Fax: 815-672-1860
Mailing address:
  • Phone: 815-672-1802
  • Fax: 815-672-1860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LYNN RICHARDS
Title or Position: OWNER
Credential: CADC
Phone: 815-672-1802