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General NPI Number Information
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NPI Number | 1215104427
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Entity Type | Organization
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Legal Business Name | LIFE JOURNEYS COUNSELING INC.
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 21 S 4TH ST
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City | ST CHARLES
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State | IL
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Zip | 60174-2701
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Country | US
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Telephone | 630-584-8284
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Fax |
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Provider Business Mailing Address
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Address Line | 21 S 4TH ST
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City | ST CHARLES
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State | IL
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Zip | 60174-2701
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Country | US
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Telephone | 630-584-8284
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | KATHLEEN KELLY WEISSER
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Credential |
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Telephone | 630-584-8284
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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 | 149010644
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License Number State | IL
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