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General NPI Number Information
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NPI Number | 1558499020
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Entity Type | Organization
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Legal Business Name | MCINNES COUNSELING SERVICES INC
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/05/2008
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Provider Practice Location Address
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Address Line | 110 MOONEY DR STE.#1
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City | BOURBONNAIS
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State | IL
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Zip | 60914-2171
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Country | US
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Telephone | 815-933-7887
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Fax | 815-933-7870
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Provider Business Mailing Address
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Address Line | 110 MOONEY DR STE.#1
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City | BOURBONNAIS
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State | IL
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Zip | 60914-2171
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Country | US
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Telephone | 815-933-7887
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Fax | 815-933-7870
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Authorized Official
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Title or Position | PRESIDENT
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Name | RUTH ANN MCINNES
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Credential | LCPC
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Telephone | 815-933-7887
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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 | 180-001816
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License Number State | IL
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