Be The Change Counseling Services PC
Clinic/Center, Mental Health (Including Community Mental Health Center) in Grayslake, IL. Organization (NPI-2).
NPI number1932535382
StatusActive
Last updated in NPPESSep 17, 2013
Details
- NPI
- 1932535382
- Entity type
- Organization (NPI-2)
- Legal business name
- Be The Change Counseling Services PC
- Organization subpart
- No
- Enumeration date
- Sep 17, 2013
- Last updated
- Sep 17, 2013
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0801X | Clinic/Center, Mental Health (Including Community Mental Health Center) | 180007572 | IL | Yes |
Practice location
136 Center StGrayslake, IL 60030
Phone 708-691-3663
Mailing address
1011 Mackenzie DriveAntioch, IL 60002
Phone 708-691-3663
Authorized official
Jennifer Marie Burris
Lcpc
7086913663
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