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General NPI Number Information
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NPI Number | 1902638141
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Entity Type | Organization
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Legal Business Name | PEACE RENEWED COUNSELING LLC
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Dates
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Enumeration Date | 08/16/2024
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 201 E ARMY TRAIL RD STE 207
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2103
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Country | US
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Telephone | 630-358-9040
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Fax | 630-982-3138
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Provider Business Mailing Address
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Address Line | 201 E ARMY TRAIL RD STE 207
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City | BLOOMINGDALE
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State | IL
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Zip | 60108-2103
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Country | US
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Telephone | 630-358-9040
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Fax | 630-982-3138
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MICHAEL J WALTERS
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Credential | MA, LCPC, CCATP
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Telephone | 630-358-9040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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