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General NPI Number Information
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NPI Number | 1356946065
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Entity Type | Organization
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Legal Business Name | GRACE COUNSELING & CONSULTING LLC
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Dates
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Enumeration Date | 12/01/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 12715 S LA CROSSE AVE
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City | ALSIP
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State | IL
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Zip | 60803-3072
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Country | US
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Telephone | 708-724-9631
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Fax |
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Provider Business Mailing Address
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Address Line | 12715 S LA CROSSE AVE APT 202
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City | ALSIP
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State | IL
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Zip | 60803-3051
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Country | US
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Telephone | 708-724-9631
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Fax |
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Authorized Official
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Title or Position | OWNER &CLINICIAN
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Name | JASMINE BANNER HUBBARD
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Credential | LCPC
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Telephone | 708-724-9631
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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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