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General NPI Number Information
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NPI Number | 1174989552
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Entity Type | Organization
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Legal Business Name | COPERTINO COUNSELING INC
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 526 CRESCENT BLVD
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City | GLEN ELLYN
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State | IL
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Zip | 60137-4176
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Country | US
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Telephone | 630-440-9013
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Fax |
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Provider Business Mailing Address
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Address Line | 526 CRESCENT BLVD
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City | GLEN ELLYN
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State | IL
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Zip | 60137-4176
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Country | US
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Telephone | 630-440-9013
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Fax |
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Authorized Official
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Title or Position | CLINICAL PROFESSIONAL COUNSELOR
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Name | MARK COPERTINO
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Credential | MS, LCPC
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Telephone | 630-440-9013
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 180.009951
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 180.009951
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License Number State | IL
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