Provider Demographics
NPI:1326396318
Name:WATERBROOK COUNSELING SERVICES, P.C.
Entity Type:Organization
Organization Name:WATERBROOK COUNSELING SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:STANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-559-5958
Mailing Address - Street 1:1649 W SHERWIN AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626-1900
Mailing Address - Country:US
Mailing Address - Phone:773-559-5958
Mailing Address - Fax:
Practice Address - Street 1:407 S DEARBORN ST
Practice Address - Street 2:600C
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-1136
Practice Address - Country:US
Practice Address - Phone:773-559-5958
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008054101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty