1548092794 NPI number — THE WELL COUNSELING PRACTICE, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548092794 NPI number — THE WELL COUNSELING PRACTICE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE WELL COUNSELING PRACTICE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548092794
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 N MILWAUKEE AVE STE 1097
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERNON HILLS
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60061-1574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2231 SHILOH DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-200-7693
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/16/2024

Additional Information

Authorized Official

Authorized Official Last Name:
SPEAR
Authorized Official First Name:
BRITTANY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/LCPC
Authorized Official Telephone Number:
309-200-7693

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1760974737 . This is a "NATIONAL PLAN & PROVIDER ENUMERATION SYSTEM" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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