Provider Demographics
NPI:1215104427
Name:LIFE JOURNEYS COUNSELING INC.
Entity type:Organization
Organization Name:LIFE JOURNEYS COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:WEISSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-584-8284
Mailing Address - Street 1:21 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2701
Mailing Address - Country:US
Mailing Address - Phone:630-584-8284
Mailing Address - Fax:
Practice Address - Street 1:21 S 4TH ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2701
Practice Address - Country:US
Practice Address - Phone:630-584-8284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149010644101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty