Provider Demographics
NPI:1053765776
Name:PSYCHOLOGICAL COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:PSYCHOLOGICAL COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATARZYNA
Authorized Official - Middle Name:BLANKA
Authorized Official - Last Name:PILEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, CADC
Authorized Official - Phone:847-907-1166
Mailing Address - Street 1:405 LAKE COOK RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-4993
Mailing Address - Country:US
Mailing Address - Phone:947-907-1166
Mailing Address - Fax:847-236-1720
Practice Address - Street 1:405 LAKE COOK RD
Practice Address - Street 2:SUITE 203
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-4993
Practice Address - Country:US
Practice Address - Phone:947-907-1166
Practice Address - Fax:847-236-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180009107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty