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General NPI Number Information
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NPI Number | 1467314096
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Entity Type | Organization
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Legal Business Name | BALANCED COUNSELING AND PSYCHOTHERAPY SERVICES PLLC
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 4355 N WESTERN AVE
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City | CHICAGO
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State | IL
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Zip | 60618-1621
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Country | US
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Telephone | 312-600-0534
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Fax |
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Provider Business Mailing Address
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Address Line | 920 JUNIPER RD
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City | GLENVIEW
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State | IL
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Zip | 60025-3322
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Country | US
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Telephone | 315-489-8206
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MICHAEL RAYMOND O'CONNELL
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Credential | LCSW
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Telephone | 315-489-8206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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