Provider Demographics
NPI:1598277147
Name:EAST AURORA COUNSELING LTD
Entity type:Organization
Organization Name:EAST AURORA COUNSELING LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ALLER
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:630-486-3800
Mailing Address - Street 1:2755 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:IL
Mailing Address - Zip Code:60502-9745
Mailing Address - Country:US
Mailing Address - Phone:630-486-3800
Mailing Address - Fax:630-486-3800
Practice Address - Street 1:2755 CHURCH RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9745
Practice Address - Country:US
Practice Address - Phone:630-486-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL312961335001Medicaid
IL1205352192OtherCAQH