MEDICARE: ERAWAN COUNSELING, 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
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1679177919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERAWAN COUNSELING, LLC

Provider Business Mailing Address
First Line	:	427 N BROAD ST
Second Line	:
City	:	GRIFFITH
State	:	IN
Zip	:	46319-2223
Country	:	US
Telephone Number	:	708-710-3696
Fax Number	:

Provider Business Practice Location Address
First Line	:	427 N BROAD ST
Second Line	:
City	:	GRIFFITH
State	:	IN
Zip	:	46319-2223
Country	:	US
Telephone Number	:	708-710-3696
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PSYCHOTHERAPIST
Name	:	MS. KIMBERLY JOY DE JONG
Credential	:	MA, LCPC, LMHC
Telephone Number	:	708-710-3696

Provider Enumeration Date	:	11/27/2020
Last Update Date	:	11/27/2020

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Directions to “ERAWAN COUNSELING, LLC ” Practice Location

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