Provider Demographics
NPI:1902638141
Name:PEACE RENEWED COUNSELING LLC
Entity type:Organization
Organization Name:PEACE RENEWED COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC, CCATP
Authorized Official - Phone:630-358-9040
Mailing Address - Street 1:201 E ARMY TRAIL RD STE 207
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-2103
Mailing Address - Country:US
Mailing Address - Phone:630-358-9040
Mailing Address - Fax:630-982-3138
Practice Address - Street 1:201 E ARMY TRAIL RD STE 207
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2103
Practice Address - Country:US
Practice Address - Phone:630-358-9040
Practice Address - Fax:630-982-3138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health