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General NPI Number Information
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NPI Number | 1538673801
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Entity Type | Organization
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Legal Business Name | MOLLY JO COUNSELING & ART THERAPY INC
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Dates
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Enumeration Date | 11/25/2017
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 29W170 BUTTERFIELD RD STE 103
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City | WARRENVILLE
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State | IL
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Zip | 60555-2807
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Country | US
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Telephone | 331-465-1153
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Fax |
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Provider Business Mailing Address
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Address Line | 3486 WILD PRAIRIE LN
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City | GENEVA
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State | IL
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Zip | 60134-3963
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Country | US
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Telephone | 920-698-1886
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOLLY ANSARI
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Credential | LCPC, ATR
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Telephone | 920-698-1886
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 180009952
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | 180009952
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 180009952
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License Number State | IL
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