=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609760032
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COURAGE AND CLARITY THERAPY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2025
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 132 W LAKE ST # 10
-----------------------------------------------------
City | BLOOMINGDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60108-1020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-757-3939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 132 W LAKE ST # 10
-----------------------------------------------------
City | BLOOMINGDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60108-1020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-757-3939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LCPC
-----------------------------------------------------
Name | CHRISTOPHER SCROPOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 847-757-3939
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------