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General NPI Number Information
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NPI Number | 1164980983
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Entity Type | Organization
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Legal Business Name | INNER GROWTH THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 03/11/2019
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 825 W STATE ST STE 119D
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City | GENEVA
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State | IL
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Zip | 60134-2079
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Country | US
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Telephone | 630-296-9566
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Fax |
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Provider Business Mailing Address
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Address Line | 103 N 4TH AVE
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City | SAINT CHARLES
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State | IL
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Zip | 60174-2001
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Country | US
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Telephone | 630-296-9566
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALEXANDRA GONZALEZ-KONOPACKI
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Credential | LCSW
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Telephone | 630-296-9566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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