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General NPI Number Information
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NPI Number | 1205137346
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Entity Type | Organization
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Legal Business Name | GREAT CHANGES COUNSELING SERVICES, P.C.
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Dates
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Enumeration Date | 11/05/2010
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Last Update Date | 02/06/2011
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Provider Practice Location Address
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Address Line | 9435 BORMET DR STE 5
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City | MOKENA
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State | IL
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Zip | 60448-7401
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Country | US
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Telephone | 815-260-2566
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Fax |
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Provider Business Mailing Address
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Address Line | 9435 BORMET DR STE 5
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City | MOKENA
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State | IL
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Zip | 60448-7401
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Country | US
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Telephone | 815-260-2566
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DONNA M WELTER
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Credential | LCSW
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Telephone | 815-260-2566
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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 | 149010490
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License Number State | IL
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