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General NPI Number Information
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NPI Number | 1144817909
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Entity Type | Organization
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Legal Business Name | JR COUNSELING SERVICES INC
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Dates
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Enumeration Date | 12/28/2020
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Last Update Date | 12/28/2020
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Provider Practice Location Address
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Address Line | 82 S LA GRANGE RD STE 210
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City | LA GRANGE
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State | IL
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Zip | 60525-6348
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Country | US
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Telephone | 708-996-1294
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Fax |
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Provider Business Mailing Address
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Address Line | 405 OAK AVE
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City | WESTMONT
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State | IL
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Zip | 60559-2043
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | JENNIFER WATERMAN
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Credential | LCSW
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Telephone | 708-996-1294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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