=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679234165
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVANSTON COUNSELING, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2022
-----------------------------------------------------
Last Update Date | 02/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 636 CHURCH ST STE 603
-----------------------------------------------------
City | EVANSTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60201-4586
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-983-4444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1114 JUDSON AVE
-----------------------------------------------------
City | EVANSTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60202-1315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-983-8444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | CATHERINE BOYCE
-----------------------------------------------------
Credential | LCSW, PHD
-----------------------------------------------------
Telephone | 773-983-8444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------