Provider Demographics
NPI:1568721447
Name:OAK BROOK COUNSELING & WELLNESS LTD
Entity Type:Organization
Organization Name:OAK BROOK COUNSELING & WELLNESS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINCAL PROFESSIONAL COUNS
Authorized Official - Prefix:MRS
Authorized Official - First Name:SABRINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GOSMIRE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:630-710-5729
Mailing Address - Street 1:1413 S ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-4118
Mailing Address - Country:US
Mailing Address - Phone:630-710-5729
Mailing Address - Fax:
Practice Address - Street 1:1010 JORIE BLVD
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-2215
Practice Address - Country:US
Practice Address - Phone:630-710-5729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-11
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005477251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health