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General NPI Number Information
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NPI Number | 1124498266
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Entity Type | Organization
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Legal Business Name | ESSENTIAL ELEMENTS COUNSELING
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Dates
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Enumeration Date | 10/01/2015
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Last Update Date | 10/01/2015
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Provider Practice Location Address
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Address Line | 402 W BOUGHTON RD SUITE G
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1872
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Country | US
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Telephone | 312-971-6653
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Fax | 888-559-6640
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Provider Business Mailing Address
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Address Line | 402 W BOUGHTON RD SUITE G
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City | BOLINGBROOK
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State | IL
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Zip | 60440-1872
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Country | US
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Telephone | 312-971-6653
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Fax | 888-559-6640
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Authorized Official
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Title or Position | OWNER
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Name | BRENDA WHITE
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Credential | LCPC
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Telephone | 312-971-6653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 180.009144
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License Number State | IL
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