Provider Demographics
NPI:1316660046
Name:SERENITY MENTAL HEALTH COUNSELING, PLLC
Entity type:Organization
Organization Name:SERENITY MENTAL HEALTH COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:EISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-707-3068
Mailing Address - Street 1:2524 LEACH DR
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8906
Mailing Address - Country:US
Mailing Address - Phone:631-707-3068
Mailing Address - Fax:
Practice Address - Street 1:24W788 75TH ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60565-1684
Practice Address - Country:US
Practice Address - Phone:516-220-5839
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty