Healthcare Provider Details

I. General information

NPI: 1174436729
Provider Name (Legal Business Name): THE NEW PURPLE WELLNESS COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2619 W HEADING AVE STE 307
WEST PEORIA IL
61604-4971
US

IV. Provider business mailing address

7613 N BOSWORTH AVE APT 3E
CHICAGO IL
60626-6244
US

V. Phone/Fax

Practice location:
  • Phone: 309-220-8597
  • Fax: 309-316-1334
Mailing address:
  • Phone: 312-344-3132
  • Fax: 309-316-1334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN HOWARD
Title or Position: MANAGING DIRECTOR
Credential: LCPC, LPC
Phone: 913-530-2976