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General NPI Number Information
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NPI Number | 1477069847
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Entity Type | Organization
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Legal Business Name | MOBRE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 12/21/2017
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Last Update Date | 12/21/2017
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Provider Practice Location Address
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Address Line | 119 W 1ST ST STE 110
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City | DIXON
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State | IL
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Zip | 61021-3056
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Country | US
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Telephone | 815-285-3073
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Fax |
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Provider Business Mailing Address
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Address Line | 119 W 1ST ST STE 110
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City | DIXON
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State | IL
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Zip | 61021-3056
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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 | OWNER
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Name | BROOKE GARCIA-NETTZ
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Credential | MA, LCPC
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Telephone | 815-994-2083
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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 | 180.010319
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License Number State | IL
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