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General NPI Number Information
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NPI Number | 1265291785
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Entity Type | Organization
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Legal Business Name | ECHO GLEN THERAPY PLLC
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Dates
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Enumeration Date | 03/18/2024
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 12627 W 143RD ST
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City | HOMER GLEN
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State | IL
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Zip | 60491-8381
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Country | US
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Telephone | 708-584-3037
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Fax |
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Provider Business Mailing Address
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Address Line | 4929 COMMONWEALTH AVE
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City | WESTERN SPRINGS
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State | IL
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Zip | 60558-1276
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LINDA GRUSH
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Credential | LCPC
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Telephone | 708-584-3037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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