Healthcare Provider Details

I. General information

NPI: 1639628241
Provider Name (Legal Business Name): PETER ADAM TRUELL LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2016
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 E HAWTHORN PKWY STE 235
VERNON HILLS IL
60061-1454
US

IV. Provider business mailing address

W175 N1110 STONEWOOD DR
GERMANTOWN WI
53022-6511
US

V. Phone/Fax

Practice location:
  • Phone: 888-428-7890
  • Fax: 877-428-7891
Mailing address:
  • Phone: 800-438-1772
  • Fax: 262-293-9737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17477-130
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.011893
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2618-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: