Organization Name: | FAITHLIFE COUNSELING |
NPI Number: | 1295117968 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARY BETH BUSSERT (PRESIDENT) |
Mailing Address: | 2215 Lakeside Dr Bannockburn |
State: | IL US |
Postal Code: | 600151265 |
Phone Number: | 8472951600 |
Fax Number: | 8472951609 |
NPI Enumeration Date: | 06/18/2015 |
NPI Last Update Date: | 06/18/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0850X |
License Number: | 180004924 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Adult Mental Health |
Taxonomy Definition: | An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in adults. |