Provider Demographics
NPI:1245773910
Name:INNER FIRE COUNSELING, LLC
Entity Type:Organization
Organization Name:INNER FIRE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARRIAGE AND FAMILY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:PROCEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-383-7050
Mailing Address - Street 1:123 W WASHINGTON ST
Mailing Address - Street 2:SUITE 325
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8254
Mailing Address - Country:US
Mailing Address - Phone:630-383-7050
Mailing Address - Fax:630-383-7050
Practice Address - Street 1:123 W WASHINGTON ST
Practice Address - Street 2:SUITE 325
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8254
Practice Address - Country:US
Practice Address - Phone:630-383-7050
Practice Address - Fax:630-383-7050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000917106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty