Healthcare Provider Details

I. General information

NPI: 1811891492
Provider Name (Legal Business Name): LOVE WITHIN THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2836 WALL AVE
WAUKEGAN IL
60087-3507
US

IV. Provider business mailing address

2836 WALL AVE
WAUKEGAN IL
60087-3507
US

V. Phone/Fax

Practice location:
  • Phone: 224-381-8977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MAYRA SOTOMAYOR
Title or Position: THERAPIST
Credential: LCPC
Phone: 224-381-8977