Provider Demographics
NPI:1093441719
Name:POSITIVE DIRECTION COUNSELING, PC
Entity Type:Organization
Organization Name:POSITIVE DIRECTION COUNSELING, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JAYME
Authorized Official - Middle Name:EVELYN
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-822-5133
Mailing Address - Street 1:305 N MILL ST
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:IL
Mailing Address - Zip Code:61764-1823
Mailing Address - Country:US
Mailing Address - Phone:815-822-5133
Mailing Address - Fax:815-513-6170
Practice Address - Street 1:305 N MILL ST
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:IL
Practice Address - Zip Code:61764-1823
Practice Address - Country:US
Practice Address - Phone:815-822-5133
Practice Address - Fax:815-513-6170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)