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General NPI Number Information
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NPI Number | 1629804356
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Entity Type | Organization
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Legal Business Name | GALENA RIVER COUNSELING AND RETREATS
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 800 SPRING ST STE 101
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City | GALENA
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State | IL
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Zip | 61036-2003
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Country | US
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Telephone | 773-454-9176
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Fax |
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Provider Business Mailing Address
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Address Line | 1 CAYUGA TRL
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City | GALENA
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State | IL
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Zip | 61036-9430
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Country | US
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Telephone | 773-454-9176
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | THOMAS JOHN DENNIS
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Credential | LCPC
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Telephone | 773-454-9176
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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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