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General NPI Number Information
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NPI Number | 1427462191
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Entity Type | Organization
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Legal Business Name | WIRTH COUNSELING SERVICES, P.C.
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Dates
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Enumeration Date | 06/20/2014
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Last Update Date | 06/20/2014
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Provider Practice Location Address
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Address Line | 19250 EVERETT LN SUITE #102
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City | MOKENA
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State | IL
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Zip | 60448-8942
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Country | US
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Telephone | 708-925-7258
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Fax |
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Provider Business Mailing Address
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Address Line | 680 LENOX ST
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City | NEW LENOX
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State | IL
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Zip | 60451-4200
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Country | US
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Telephone | 815-717-8575
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DENISE ANN WIRTH
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Credential | LCPC
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Telephone | 708-925-7258
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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 | 180009160
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License Number State | IL
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