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General NPI Number Information
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NPI Number | 1801613831
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Entity Type | Organization
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Legal Business Name | MIDWEST CLINICAL COUNSELING ASSOCIATES LLC
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Dates
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Enumeration Date | 09/23/2024
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Last Update Date | 01/11/2025
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Provider Practice Location Address
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Address Line | 4300 COMMERCE CT STE 300-7
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City | LISLE
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State | IL
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Zip | 60532-3709
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Country | US
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Telephone | 331-305-3246
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 COMMERCE CT STE 300-7
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City | LISLE
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State | IL
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Zip | 60532-3709
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Country | US
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Telephone | 630-697-0197
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MR. SEAN MICHAEL BERBERT
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Credential | LCPC
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Telephone | 630-697-0197
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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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