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General NPI Number Information
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NPI Number | 1922542208
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Entity Type | Organization
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Legal Business Name | TRANSFORMATIVE GROWTH COUNSELING FOUNDATION
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Dates
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Enumeration Date | 12/06/2016
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Last Update Date | 12/06/2016
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Provider Practice Location Address
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Address Line | 501 6TH AVE SUITE 8
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City | ROCHELLE
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State | IL
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Zip | 61068-1567
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Country | US
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Telephone | 630-423-6010
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Fax |
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Provider Business Mailing Address
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Address Line | 501 6TH AVE
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City | ROCHELLE
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State | IL
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Zip | 61068-1567
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Country | US
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Telephone | 630-423-6010
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, LCPC
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Name | JESSICA NORMAN
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Credential | LCPC
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Telephone | 630-423-6010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 180010623
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License Number State | IL
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