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General NPI Number Information
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NPI Number | 1063997369
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Entity Type | Organization
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Legal Business Name | CATALYST COUNSELING LLC
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Dates
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Enumeration Date | 10/02/2018
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Last Update Date | 10/02/2018
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Provider Practice Location Address
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Address Line | 134 W LAKE ST STE 6
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-1020
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Country | US
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Telephone | 224-325-4513
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Fax |
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Provider Business Mailing Address
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Address Line | 4304 W SHAMROCK LN APT 2B
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City | MCHENRY
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State | IL
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Zip | 60050-3141
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Country | US
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Telephone | 224-231-7932
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Fax |
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Authorized Official
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Title or Position | LCPC/OWNER
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Name | MRS. JASMINE D MENSER-LUST
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Credential | LCPC
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Telephone | 224-325-4513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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