Provider Demographics
NPI:1558052035
Name:IMPERFECT HARMONY COUNSELING LTD
Entity Type:Organization
Organization Name:IMPERFECT HARMONY COUNSELING LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLAUDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-650-2660
Mailing Address - Street 1:201 E COOK AVE APT 104
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2038
Mailing Address - Country:US
Mailing Address - Phone:847-650-2660
Mailing Address - Fax:
Practice Address - Street 1:495 N RIVERSIDE DR STE 104
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5919
Practice Address - Country:US
Practice Address - Phone:847-650-2660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180012426Medicaid