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General NPI Number Information
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NPI Number | 1912737776
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Entity Type | Organization
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Legal Business Name | RESTORED SERENITY COUNSELING SERVICES
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Dates
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Enumeration Date | 08/06/2024
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 3129 REHBEHN CT
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City | YORKVILLE
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State | IL
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Zip | 60560-2435
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Country | US
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Telephone | 773-370-8890
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Fax |
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Provider Business Mailing Address
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Address Line | 3129 REHBEHN CT
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City | YORKVILLE
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State | IL
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Zip | 60560-2435
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RAYMOND SULLIVAN
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Credential | LCPC
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Telephone | 773-370-8890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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