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General NPI Number Information
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NPI Number | 1942627971
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Entity Type | Organization
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Legal Business Name | PERSONAL GROWTH CENTER, LTD.
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Dates
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Enumeration Date | 03/27/2014
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 3612 LINCOLN HWY SUITE 6
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1627
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Country | US
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Telephone | 708-503-9400
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Fax | 708-503-0463
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Provider Business Mailing Address
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Address Line | 3612 LINCOLN HWY SUITE 6
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City | OLYMPIA FIELDS
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State | IL
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Zip | 60461-1627
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Country | US
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Telephone | 708-503-9400
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Fax | 708-503-0463
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Authorized Official
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Title or Position | OWNER
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Name | DONNA LEE ULANOWSKI
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Credential | M.A., L.C.P.C
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Telephone | 708-503-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.002079
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License Number State | IL
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