Provider Demographics
NPI:1417780867
Name:VIVERE COUNSELING
Entity type:Organization
Organization Name:VIVERE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-946-9500
Mailing Address - Street 1:PO BOX 6224
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-6224
Mailing Address - Country:US
Mailing Address - Phone:630-946-9500
Mailing Address - Fax:
Practice Address - Street 1:121 FAIRFIELD WAY STE 102
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1555
Practice Address - Country:US
Practice Address - Phone:630-946-9500
Practice Address - Fax:630-597-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1306948351Medicaid