Provider Demographics
NPI:1588203541
Name:COUNSELING WITH PS
Entity Type:Organization
Organization Name:COUNSELING WITH PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAYAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SUD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-308-0453
Mailing Address - Street 1:485 FOXBOROUGH TRL
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4835
Mailing Address - Country:US
Mailing Address - Phone:708-308-0453
Mailing Address - Fax:
Practice Address - Street 1:310 N CONVENT ST
Practice Address - Street 2:
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2099
Practice Address - Country:US
Practice Address - Phone:708-308-0453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-22
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL336782721001Medicaid