=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740705946
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEA GLASS COUNSELING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/08/2017
-----------------------------------------------------
Last Update Date | 01/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 203 N MCLEAN ST
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61748-7750
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-740-1157
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 171
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61748-0171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-740-1157
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, LICENSED THERAPIST
-----------------------------------------------------
Name | DARCI NEWTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 309-740-1157
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 149.019425
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149.019425
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------