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General NPI Number Information
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NPI Number | 1245710821
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Entity Type | Organization
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Legal Business Name | NEXUS COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 08/14/2018
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Last Update Date | 08/14/2018
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Provider Practice Location Address
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Address Line | 1800 RIDGE RD STE 3
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City | HOMEWOOD
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State | IL
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Zip | 60430-1723
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Country | US
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Telephone | 773-357-6361
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Fax |
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Provider Business Mailing Address
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Address Line | 1756 BURR OAK RD
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City | HOMEWOOD
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State | IL
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Zip | 60430-1811
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Country | US
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Telephone | 773-771-7138
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/LCPC
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Name | KYLE RAYMOND MILLER
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Credential | LCPC
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Telephone | 773-357-6361
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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 | 180011166
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License Number State | IL
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