Provider Demographics
NPI:1588148795
Name:NORTHERN LIGHT COUNSELING & CONSULTATION LLC
Entity type:Organization
Organization Name:NORTHERN LIGHT COUNSELING & CONSULTATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAGO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LCPC
Authorized Official - Phone:708-692-8462
Mailing Address - Street 1:18700 WOLF RD STE 245
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8603
Mailing Address - Country:US
Mailing Address - Phone:708-692-8462
Mailing Address - Fax:
Practice Address - Street 1:18700 WOLF RD STE 245
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8603
Practice Address - Country:US
Practice Address - Phone:708-692-8462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1922425222OtherINDIVIDUAL NPI