Healthcare Provider Details

I. General information

NPI: 1548465313
Provider Name (Legal Business Name): LOVE-LIGHT CHRISTIAN COUNSELING, NFP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 DAWN LN
ZION IL
60099-5108
US

IV. Provider business mailing address

2018 DAWN LN
ZION IL
60099-5108
US

V. Phone/Fax

Practice location:
  • Phone: 847-731-3192
  • Fax:
Mailing address:
  • Phone: 847-731-3192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. WILLIAM V RHODES
Title or Position: PRESIDENT
Credential: PSYD
Phone: 847-731-3192