1629837430 NPI number — VENCES COUNSELING

Table of content: (NPI 1629837430)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629837430 NPI number — VENCES COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VENCES COUNSELING
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:
1629837430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 MYRTLE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUKEGAN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60085-3840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-596-0785
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
117 E PALATINE RD STE 207
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALATINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60067-5130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-450-6190
Provider Business Practice Location Address Fax Number:
847-450-6197
Provider Enumeration Date:
03/14/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VENCES
Authorized Official First Name:
INDIRA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
847-450-6190

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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