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General NPI Number Information
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NPI Number | 1457870388
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE FAMILY COUNSELING LLC
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 2200 S MAIN ST STE 217E
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City | LOMBARD
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State | IL
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Zip | 60148-5334
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Country | US
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Telephone | 630-770-5134
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Fax |
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Provider Business Mailing Address
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Address Line | 427 COUNTRYSIDE DR
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City | WHEATON
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State | IL
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Zip | 60187-3212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | JOHN KOMPERDA
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Credential | LCPC
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Telephone | 708-715-8448
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 32003
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 180.010660
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180.010660
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License Number State | IL
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