Provider Demographics
NPI:1306248497
Name:YOUR STORY COUNSELING, P.C.
Entity type:Organization
Organization Name:YOUR STORY COUNSELING, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:Q
Authorized Official - Last Name:BECKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-442-1895
Mailing Address - Street 1:4745 MAIN STREET
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LISLE
Mailing Address - State:ILLINOIS
Mailing Address - Zip Code:60532
Mailing Address - Country:UM
Mailing Address - Phone:630-442-1895
Mailing Address - Fax:630-442-1895
Practice Address - Street 1:4745 MAIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:LISLE
Practice Address - State:IL
Practice Address - Zip Code:60532-1754
Practice Address - Country:US
Practice Address - Phone:630-442-1895
Practice Address - Fax:630-442-1896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-19
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0169451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty