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NPI Code Detail

MEDICARE: THE CENTER FOR COURAGEOUS LIVING LLC

MEDICARE: THE CENTER FOR COURAGEOUS LIVING LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1205799475
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE CENTER FOR COURAGEOUS LIVING LLC
Provider Business Mailing Address
First Line : 377 W VIRGINIA ST
Second Line :
City : CRYSTAL LAKE
State : IL
Zip : 60014-5756
Country : US
Telephone Number : 815-707-4806
Fax Number : 815-977-8715
Provider Business Practice Location Address
First Line : 377 W VIRGINIA ST
Second Line :
City : CRYSTAL LAKE
State : IL
Zip : 60014-5756
Country : US
Telephone Number : 815-707-4806
Fax Number : 815-977-8715
Authorized Official
Title or Position : OWNER
Name : KATIE MARIE KROENING
Credential :
Telephone Number : 815-707-4806
Provider Enumeration Date : 12/04/2025
Last Update Date : 12/18/2025

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Directions to “THE CENTER FOR COURAGEOUS LIVING LLC ” Practice Location

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