=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407634504
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEAL COUNSELING AND WELLNESS LTD.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2023
-----------------------------------------------------
Last Update Date | 09/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6517 W HIGHLAND AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60631-2043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-829-8743
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1509 WAUKEGAN RD STE 1139
-----------------------------------------------------
City | GLENVIEW
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60025-2122
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-829-8743
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING
-----------------------------------------------------
Name | ROBERT FOREMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 630-313-0069
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------