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General NPI Number Information
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NPI Number | 1033811963
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Entity Type | Organization
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Legal Business Name | SIMPLE COUNSELING LLC
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Dates
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Enumeration Date | 03/22/2023
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Last Update Date | 04/02/2023
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Provider Practice Location Address
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Address Line | 2501 CHATHAM RD STE 8115
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 224-201-7333
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD STE 8115
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 224-201-7333
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Fax |
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Authorized Official
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Title or Position | CLINICIAN/THERAPIST
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Name | ISIS MENDOZAGARNICA
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Credential | L.C.P.C.
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Telephone | 224-201-7333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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