Provider Demographics
NPI:1164980983
Name:INNER GROWTH THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:INNER GROWTH THERAPY SERVICES, LLC
Other - Org Name:ALEXANDRA GONZALEZ LCSW, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ-KONOPACKI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-296-9566
Mailing Address - Street 1:103 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2001
Mailing Address - Country:US
Mailing Address - Phone:630-296-9566
Mailing Address - Fax:
Practice Address - Street 1:825 W STATE ST STE 119D
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2079
Practice Address - Country:US
Practice Address - Phone:630-296-9566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty