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General NPI Number Information
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NPI Number | 1336961507
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Entity Type | Organization
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Legal Business Name | WELLBOUND COUNSELING
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 508 CENTRAL AVE SUITE 210
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City | HIGHLAND PARK
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State | IL
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Zip | 60035
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Country | US
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Telephone | 847-780-0055
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Fax | 847-615-0248
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Provider Business Mailing Address
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Address Line | 1344 BURR OAK. RD.
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City | LAKE FOREST
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State | IL
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Zip | 60045
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Country | US
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Telephone | 847-668-5660
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Fax | 847-615-0248
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Authorized Official
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Title or Position | OWNER, CLINICAL DIRECTOR
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Name | MR. ANTHONY IACUBINO
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Credential | LCPC
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Telephone | 847-668-5660
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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 |
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License Number State |
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