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General NPI Number Information
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NPI Number | 1639523558
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Entity Type | Organization
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Legal Business Name | ETHOS COUNSELING GROUP, LIMITED
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Dates
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Enumeration Date | 04/17/2016
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Last Update Date | 03/26/2017
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Provider Practice Location Address
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Address Line | 2210 MIDWEST RD SUITE 213
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City | OAK BROOK
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State | IL
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Zip | 60523-1280
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Country | US
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Telephone | 630-457-7176
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Fax |
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Provider Business Mailing Address
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Address Line | 2210 MIDWEST RD SUITE 213
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City | OAK BROOK
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State | IL
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Zip | 60523-1280
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Country | US
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Telephone | 630-828-8120
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. CAROL KRUSE
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Credential | LCPC, NCC
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Telephone | 630-457-7176
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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 | 180007649
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License Number State | IL
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