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General NPI Number Information
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NPI Number | 1144789439
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Entity Type | Organization
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Legal Business Name | HEALED AND WHOLE COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 03/15/2019
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 53 W JACKSON BLVD STE 1605
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City | CHICAGO
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State | IL
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Zip | 60604-3762
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Country | US
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Telephone | 312-725-9980
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Fax |
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Provider Business Mailing Address
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Address Line | 53 W JACKSON BLVD STE 1605
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City | CHICAGO
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State | IL
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Zip | 60604-3762
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Country | US
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Telephone | 312-725-9980
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | LAUREN MCBRIDE
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Credential | LCPC
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Telephone | 708-264-4627
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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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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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