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General NPI Number Information
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NPI Number | 1326396318
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Entity Type | Organization
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Legal Business Name | WATERBROOK COUNSELING SERVICES, P.C.
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Dates
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Enumeration Date | 08/22/2012
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Last Update Date | 08/22/2012
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Provider Practice Location Address
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Address Line | 407 S DEARBORN ST 600C
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City | CHICAGO
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State | IL
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Zip | 60605-1136
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Country | US
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Telephone | 773-559-5958
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Fax |
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Provider Business Mailing Address
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Address Line | 1649 W SHERWIN AVE APT 3
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City | CHICAGO
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State | IL
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Zip | 60626-1900
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Country | US
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Telephone | 773-559-5958
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Fax |
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Authorized Official
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Title or Position | FOUNDER/PRESIDENT
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Name | MR. ROBERT PRESTON STANFORD
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Credential | L.C.P.C.
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Telephone | 773-559-5958
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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 | 180.008054
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License Number State | IL
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