=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629884200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCCARTHY COUNSELING AND CONSULTING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/09/2024
-----------------------------------------------------
Last Update Date | 12/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34121 N US HIGHWAY 45
-----------------------------------------------------
City | GRAYSLAKE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60030-1768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-239-2204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24007 W MEADOW LN
-----------------------------------------------------
City | GRAYSLAKE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60030-9534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 608-239-2204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JULIE CROWE-MCCARTHY
-----------------------------------------------------
Credential | LCPC
-----------------------------------------------------
Telephone | 608-239-2204
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------