Provider Demographics
NPI:1235772625
Name:HERITAGE COUNSELING CENTER
Entity Type:Organization
Organization Name:HERITAGE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-577-8970
Mailing Address - Street 1:24020 W RIVERWALK CT STE 100
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-7105
Mailing Address - Country:US
Mailing Address - Phone:815-577-8970
Mailing Address - Fax:
Practice Address - Street 1:24020 W RIVERWALK CT STE 100
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-7105
Practice Address - Country:US
Practice Address - Phone:815-577-8970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty