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General NPI Number Information
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NPI Number | 1922234822
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Entity Type | Organization
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Legal Business Name | NORTHLIGHT COUNSELING, LLC
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 06/05/2009
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Provider Practice Location Address
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Address Line | 4180 ROUTE 83 SUITE #10
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City | LONG GROVE
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State | IL
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Zip | 60047
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Country | US
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Telephone | 847-962-5234
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Fax |
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Provider Business Mailing Address
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Address Line | 4180 ROUTE 83 SUITE #10
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City | LONG GROVE
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State | IL
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Zip | 60047
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Country | US
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Telephone | 847-962-5234
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Fax |
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Authorized Official
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Title or Position | OWNER/SOLE PROPRIETOR
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Name | JARIL FAITH GALLUP
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Credential | LCSW
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Telephone | 847-962-5234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149-008819
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License Number State | IL
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