Provider Demographics
NPI:1477268134
Name:IRONWOOD COUNSELING, LLC
Entity Type:Organization
Organization Name:IRONWOOD COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SUMMERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, MA, MS
Authorized Official - Phone:309-642-0262
Mailing Address - Street 1:809 W DETWEILLER DR STE 804C
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-2132
Mailing Address - Country:US
Mailing Address - Phone:309-642-0262
Mailing Address - Fax:
Practice Address - Street 1:809 W DETWEILLER DR STE 804C
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-2132
Practice Address - Country:US
Practice Address - Phone:309-642-0262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty