Provider Demographics
NPI:1053028142
Name:GOOD LIFE COUNSELING PLLC
Entity type:Organization
Organization Name:GOOD LIFE COUNSELING PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:W
Authorized Official - Last Name:ZAMUDIO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:224-800-0165
Mailing Address - Street 1:101 N VIRGINIA ST STE 120
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3439
Mailing Address - Country:US
Mailing Address - Phone:224-762-5098
Mailing Address - Fax:
Practice Address - Street 1:101 N VIRGINIA ST STE 120
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3439
Practice Address - Country:US
Practice Address - Phone:815-893-9544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty