Provider Demographics
NPI:1578828299
Name:BENDING BIRCH COUNSELING
Entity Type:Organization
Organization Name:BENDING BIRCH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RAPACH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:224-239-5359
Mailing Address - Street 1:1250 S GROVE AVE
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-5091
Mailing Address - Country:US
Mailing Address - Phone:224-239-5359
Mailing Address - Fax:
Practice Address - Street 1:1250 S GROVE AVE
Practice Address - Street 2:SUITE # 200
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-5091
Practice Address - Country:US
Practice Address - Phone:224-239-5359
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149009744251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK36596Medicare UPIN