Provider Demographics
NPI:1457866139
Name:WALL COUNSELING AND ASSOCIATES, LLC
Entity Type:Organization
Organization Name:WALL COUNSELING AND ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:773-551-7204
Mailing Address - Street 1:688 N MILWAUKEE AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5912
Mailing Address - Country:US
Mailing Address - Phone:773-551-7204
Mailing Address - Fax:
Practice Address - Street 1:688 N MILWAUKEE AVE STE 302
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-5912
Practice Address - Country:US
Practice Address - Phone:773-551-7204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008228261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)