Provider Demographics
NPI:1457842460
Name:THE CENTER FOR COURAGEOUS LIVING LLC
Entity Type:Organization
Organization Name:THE CENTER FOR COURAGEOUS LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR/OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE (KATHLEEN)
Authorized Official - Middle Name:M
Authorized Official - Last Name:KROENING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:815-707-4806
Mailing Address - Street 1:475 W TERRA COTTA AVE STE E
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-3407
Mailing Address - Country:US
Mailing Address - Phone:815-707-4806
Mailing Address - Fax:815-977-8715
Practice Address - Street 1:475 W TERRA COTTA AVE STE E
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3407
Practice Address - Country:US
Practice Address - Phone:815-707-4806
Practice Address - Fax:815-977-8715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0168051041C0700X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty