Organization Name: | JO ELLEN CARL LTD |
NPI Number: | 1215109129 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JO ELLEN CARL (PRESIDENT) |
Mailing Address: | 110 Mooney Dr Ste 1 Bourbonnais |
State: | IL US |
Postal Code: | 609142172 |
Phone Number: | 8159337887 |
Fax Number: | 8159337870 |
NPI Enumeration Date: | 03/31/2008 |
NPI Last Update Date: | 03/31/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |