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General NPI Number Information
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NPI Number | 1306658711
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Entity Type | Organization
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Legal Business Name | MOUNTAIN VALLEY COUNSELING PC
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Dates
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Enumeration Date | 01/22/2025
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 2 S ADDISON ST
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City | BENSENVILLE
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State | IL
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Zip | 60106-2126
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Country | US
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Telephone | 312-600-5194
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Fax |
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Provider Business Mailing Address
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Address Line | 800 ENTERPRISE DR STE 214
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City | OAK BROOK
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State | IL
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Zip | 60523-4218
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Country | US
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Telephone | 312-600-5194
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MR. WAJAHAT MACCI
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Credential |
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Telephone | 312-600-5061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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