Provider Demographics
NPI:1164980249
Name:BEYOND HEALING - A COUNSELING, WELLNESS & PERSONAL GROWTH CENTER
Entity Type:Organization
Organization Name:BEYOND HEALING - A COUNSELING, WELLNESS & PERSONAL GROWTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LCPC
Authorized Official - Phone:708-837-3722
Mailing Address - Street 1:13728 W CAREFREE DR
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-8655
Mailing Address - Country:US
Mailing Address - Phone:708-837-3722
Mailing Address - Fax:
Practice Address - Street 1:13728 W CAREFREE DR
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-8655
Practice Address - Country:US
Practice Address - Phone:708-837-3722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180-006920OtherLCPC