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General NPI Number Information
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NPI Number | 1922267475
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Entity Type | Organization
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Legal Business Name | SOUL CHOICE COUNSELING, LTD
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 831 FOREST AVE APT 3W
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City | EVANSTON
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State | IL
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Zip | 60202-2421
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Country | US
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Telephone | 773-332-5471
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Fax |
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Provider Business Mailing Address
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Address Line | 831 FOREST AVE #3W
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City | EVANSTON
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State | IL
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Zip | 60202-2486
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Country | US
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Telephone | 847-328-8477
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. ALYSE A. RYNOR
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Credential | L.C.S.W.
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Telephone | 847-328-8477
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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 | 149006701
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License Number State | IL
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