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General NPI Number Information
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NPI Number | 1972199099
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN COUNSELING GROUP, LLC
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Dates
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Enumeration Date | 12/13/2020
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Last Update Date | 12/13/2020
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Provider Practice Location Address
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Address Line | 2209 W WINONA ST UNIT 2
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City | CHICAGO
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State | IL
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Zip | 60625-1831
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Country | US
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Telephone | 847-652-0902
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Fax |
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Provider Business Mailing Address
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Address Line | 2209 W WINONA ST UNIT 2
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City | CHICAGO
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State | IL
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Zip | 60625-1831
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Country | US
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Telephone | 847-652-0902
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Fax |
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Authorized Official
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Title or Position | CEO AND LEAD THERAPIST
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Name | MEREDYTH BROOK
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Credential | LCPC
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Telephone | 476-520-0902
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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