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General NPI Number Information
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NPI Number | 1568721447
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Entity Type | Organization
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Legal Business Name | OAK BROOK COUNSELING & WELLNESS LTD
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Dates
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Enumeration Date | 05/11/2012
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Last Update Date | 05/11/2012
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Provider Practice Location Address
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Address Line | 1010 JORIE BLVD
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City | OAK BROOK
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State | IL
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Zip | 60523-2215
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Country | US
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Telephone | 630-710-5729
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Fax |
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Provider Business Mailing Address
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Address Line | 1413 S ADDISON AVE
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City | LOMBARD
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State | IL
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Zip | 60148-4118
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Country | US
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Telephone | 630-710-5729
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINCAL PROFESSIONAL COUNS
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Name | MRS. SABRINA R. GOSMIRE
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Credential | M.A.
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Telephone | 630-710-5729
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 180005477
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License Number State | IL
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