Provider Demographics
NPI:1467160531
Name:HOPE AND HEALING COUNSELING SERVICES
Entity Type:Organization
Organization Name:HOPE AND HEALING COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCPC
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:JERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-677-3790
Mailing Address - Street 1:616 N BRIDGEPORT TER STE L
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60046-4910
Mailing Address - Country:US
Mailing Address - Phone:224-627-8237
Mailing Address - Fax:
Practice Address - Street 1:616 N BRIDGEPORT TER STE L
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:IL
Practice Address - Zip Code:60046-4910
Practice Address - Country:US
Practice Address - Phone:224-627-8237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)