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General NPI Number Information
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NPI Number | 1134908676
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Entity Type | Organization
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Legal Business Name | SIXTY FORTY COUNSELING PLLC
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Dates
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Enumeration Date | 09/25/2023
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 475 RIVER BEND RD STE 306
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City | NAPERVILLE
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State | IL
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Zip | 60540-5277
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Country | US
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Telephone | 708-828-4636
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Fax |
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Provider Business Mailing Address
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Address Line | 475 RIVER BEND RD STE 306
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City | NAPERVILLE
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State | IL
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Zip | 60540-5277
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Country | US
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Telephone | 708-828-4636
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MR. KYLE L LISOWSKI
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Credential | ED.S, LCPC
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Telephone | 708-828-4636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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