Provider Demographics
NPI:1063997369
Name:CATALYST COUNSELING LLC
Entity type:Organization
Organization Name:CATALYST COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MENSER-LUST
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:224-325-4513
Mailing Address - Street 1:4304 W SHAMROCK LN APT 2B
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-3141
Mailing Address - Country:US
Mailing Address - Phone:224-231-7932
Mailing Address - Fax:
Practice Address - Street 1:134 W LAKE ST STE 6
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1020
Practice Address - Country:US
Practice Address - Phone:224-325-4513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-02
Last Update Date:2018-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1801209507OtherNPI