MEDICARE: ASCENT HEALING INC

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	180.009307	IL

General Provider Information

NPI Number	:	1740683390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENT HEALING INC

Provider Business Mailing Address
First Line	:	4225 SARATOGA AVE
Second Line	:	UNIT 415B
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-1972
Country	:	US
Telephone Number	:	630-707-1799
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 WINDSOR DR
Second Line	:	SUITE 113
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1536
Country	:	US
Telephone Number	:	630-707-1799
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MS. HOLLY ANNE MATTINGLY
Credential	:	LCPC
Telephone Number	:	630-707-1799

Provider Enumeration Date	:	09/26/2014
Last Update Date	:	02/03/2016

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