Provider Demographics
NPI:1407674492
Name:NOURISH WELL COUNSELING, PLLC
Entity type:Organization
Organization Name:NOURISH WELL COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCANLON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:847-533-9760
Mailing Address - Street 1:526 CRESCENT BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-4177
Mailing Address - Country:US
Mailing Address - Phone:847-533-9760
Mailing Address - Fax:
Practice Address - Street 1:526 CRESCENT BLVD STE 210
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-4177
Practice Address - Country:US
Practice Address - Phone:847-533-9760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionist